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PubMed2004

Adolescents' views on decision-making regarding risky sexual behaviour.

PURPOSE: To explore adolescents' views regarding risky sexual behaviour who were aged between 13 and 19 years. METHODS: A purposive sample was drawn from adolescents who were participating in workshops, organized by the Ministry of Health and Social Welfare. The sample consisted of a mix of in-school and out-of-school adolescents aged between 13 and 19 years. The overall aim of the workshops was to explore adolescents' views on decision-making regarding risky sexual behaviour. The educational status of participants lay between grades 0 and 12. A total of 24 focus group discussions were conducted, six in each of the four regions of Swaziland (Manzini, Hhohho, Lubombo and Shiselweni). Each group consisted of 6-12 participants. All focus group discussions were audiotaped and later transcribed. FINDINGS: The following four major themes emerged from content analysis: sexual behaviour, age at first intercourse, peer pressure and trust in the relationship. These were all found to be important factors in decision-making for risky sexual behaviours. CONCLUSIONS: Obtaining a sexual history, motivation to use condoms, guidance and counselling on ways to reduce adolescents' risk of sexual exploitation, and peer education programmes, are all of importance when aiming to reduce risky sexual behaviour. RECOMMENDATION: Adolescents should receive positive reinforcement for responsible sexual behaviour including abstinence and, where appropriate, use of active birth control.

Adolescent↗

PubMed1994

Beta 2-microglobulin and other early predictors of human immunodeficiency virus type 1-related wasting.

The objective of this study was to determine whether beta 2-microglobulin, neopterin, nutritional status, clinical status, immunosuppression, and hematologic status are predictors of human immunodeficiency virus (HIV)-related wasting and wasting syndrome. In addition, we aimed to determine which factors are early predictors and which are late predictors of wasting. For this cohort study of HIV-1-seropositive men seen semiannually from 1984 to 1991, a nested case-control design was used to analyze the predictive value of independent variables collected at baseline (first study visit for the seropositive cohort, first seropositive visit for seroconverters), 12 to 18 months prior, 6 to 12 months prior, and less than 6 months prior to the time at which case patients and control subjects were identified. Data on beta 2-microglobulin, neopterin, educational status, and diet were only available at baseline. A total of 41 case patients and 161 control subjects (n = 202) were identified. These were homosexual/bisexual men who were either HIV-seropositive on entering the study (n = 177) or who seroconverted during the study period (n = 25). Case patients were defined as men who had lost more than 10% of their baseline weight or who had a clinical diagnosis of wasting syndrome using the 1987 Centers for Disease Control definition. Control subjects had less than 5% weight loss from baseline or no weight loss at all. Four control subjects were matched to each case patient (where possible) by age and duration of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality.

BACKGROUND: The debate on breastfeeding in areas of high HIV prevalence has led to the development of simulation models that attempt to assess the risks and benefits associated with breastfeeding. An essential element of these simulations is the extent to which breastfeeding protects against infant and child mortality; however, few studies are available on this topic. We did a pooled analysis of studies that assessed the effect of not breastfeeding on the risk of death due to infectious diseases. METHODS: Studies were identified through consultations with experts in international health, and from a MEDLINE search for 1980-98. Using meta-analytical techniques, we assessed the protective effect of breastfeeding according to the age and sex of the infant, the cause of death, and the educational status of the mother. FINDINGS: We identified eight studies, data from six of which were available (from Brazil, The Gambia, Ghana, Pakistan, the Philippines, and Senegal). These studies provided information on 1223 deaths of children under two years of age. In the African studies, virtually all babies were breastfed well into the second year of life, making it impossible to include them in the analyses of infant mortality. On the basis of the other three studies, protection provided by breastmilk declined steadily with age during infancy (pooled odds ratios: 5.8 [95% CI 3.4-9.8] for infants <2 months of age, 4.1 [2.7-6.4] for 2-3-month-olds, 2.6 [1.6-3.9] for 4-5-month-olds, 1.8 [1.2-2.8] for 6-8-month-olds, and 1.4 [0.8-2.6] for 9-11-month-olds). In the first 6 months of life, protection against diarrhoea was substantially greater (odds ratio 6.1 [4.1-9.0]) than against deaths due to acute respiratory infections (2.4 [1.6-3.5]). However, for infants aged 6-11 months, similar levels of protection were observed (1.9 [1.2-3.1] and 2.5 [1.4-4.6], respectively). For second-year deaths, the pooled odds ratios from five studies ranged between 1.6 and 2.1. Protection was highest when maternal education was low. INTERPRETATION: These results may help shape policy decisions about feeding choices in the face of the HIV epidemic. Of particular relevance is the need to account for declining levels of protection with age in infancy, the continued protection afforded during the second year of life, and the question of the safety of breastmilk substitutes in families of low socioeconomic status.

Breast Feeding↗

PubMedDate not supplied

[Knowledge, attitudes and practices regarding glaucoma in the urban and suburban population of Lomé (Togo)].

PURPOSE: One of the main constraints in the prevention of blindness is the lack of awareness of people regarding eye diseases. This study was undertaken to determine the level of knowledge, the attitudes and practices regarding glaucoma in the population of Lomé. METHODS: An interview using a questionnaire was conducted among an opportunistic sample of 767 people living in the capital city of Lomé and in some of its suburbs. The interview targeted people aged 20 to 65 years; the questions were either closed or open. The interviews were conducted either in French or in the local languages where needed and in the latter case with the help of a translator. Variables measured included education status, e.g., schooling years, economic status and professional situation. RESULTS: The knowledge of eye diseases accounted for 84% among the population studied; the most well-known being myopia, cataract, presbyopia, and glaucoma in decreasing order. Glaucoma was known by 228 people (29.7%) among whom 25% were aware of glaucoma blindness cases; 61.5% declared that glaucoma was a serious condition; 4.4% admitted the use of traditional eye-healers; 56.1% were not confident in the local doctors for the treatment of glaucoma. CONCLUSION: The high proportion of people who are not confident in the capabilities of national doctors to efficiently treat glaucoma is worrying. This situation requires the set up of a rational national strategic action plan (e.g., health education) aimed at reducing the burden of glaucoma blindness in the country.

Adult↗

PubMed2001

Long-term nutritional effects of ICDS.

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7-13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were non-beneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p < 0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7-13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.

Adolescent↗

PubMed1992

Pre-frontal structural and functional deficits associated with individual differences in schizotypal personality.

This study tests the hypothesis that pre-frontal deficits underlie schizotypal personality in the normal population. Personality measures assessing features of DSM-IIIR schizotypal personality disorder (SPD) were related to left and right pre-frontal brain area assessed by magnetic resonance imaging (MRI), and neuropsychological measures of pre-frontal functioning (Wisconsin Card Sorting Task, WCST) in a group of non-institutionalized, unmedicated normal subjects. High schizotypal scores were significantly associated with reduced pre-frontal area and more WCST perseveration errors; conversely no relationships were observed between these pre-frontal measures and measures of psychosis-proneness unrelated to SPD traits. Pre-frontal structural findings were not found to be mediated by temporal lobe and posterior cortical structural deficits, height, weight, socio-economic status, education level and sex differences, while pre-frontal functional findings were not mediated by non-prefrontal cognitive ability. These findings of pre-frontal structural and functional deficits associated with schizotypal personality provide some initial converging support for a pre-frontal explanation of individual differences in schizotypal personality in the general population.

Adult↗

PubMedDate not supplied

Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: Pathologic gambling is believed to be associated with adverse health consequences, but no prior studies have rigorously evaluated these relationships. We sought to examine medical disorders and health service utilization associated with problem and pathologic gambling. METHOD: A total of 43,093 adults aged 18 years and older were evaluated in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions. Self-reported medical diagnoses and past-year medical services used were assessed. RESULTS: Pathologic gamblers were more likely than low-risk individuals to have been diagnosed with tachycardia (odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.05-2.97), angina (OR = 2.35; 95% CI = 1.33-4.15), cirrhosis (OR = 3.90; 95% CI = 1.11-13.72), and other liver disease (OR = 2.98; 95% CI = 1.07-8.26). Gambling severity was also associated with higher rates of medical utilization with pathologic gamblers more likely than low-risk individuals to have been treated in the emergency room in the year before the survey (OR = 1.98; 95% CI = 1.27-3.09). Significant effects of gambling severity remained even after controlling for demographic characteristics (age, gender, ethnicity, marital status, education, income, and region of the country) and behavioral risk factors such as body mass index, alcohol abuse and dependence, nicotine dependence, and mood and anxiety disorders. CONCLUSIONS: A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States.

Adolescent↗

PubMed1997

Alcohol use and problem drinking: prevalences in the general Rotterdam population.

Research was done on the distribution of abstinence, excessive drinking, alcohol-related problems, and problem drinking among the general population of Rotterdam, Netherlands in 1994. Prevalences are assessed among the total population and subpopulations defined by sex, age, marital status, educational level, daily activities, and income. A general population survey was conducted among a random sample of 8,000 Dutch inhabitants of Rotterdam in the 16-69 age range. The response rate was 44% (N = 3,537). The majority of the respondents were "light" or "moderate" drinkers. Prevalences of excessive drinking, alcohol-related problems (1 or more), and problem drinking in the total population were 8, 28, and 9%, respectively. It is shown that women tend to report many alcohol-use-related problems considering their relatively low consumption pattern; young men have a high prevalence of problem drinking; being single, being unemployed, and being declared unfit to work are associated with problematic drinking. The results found for socioeconomic status appear to be inconsistent.

Adolescent↗

PubMed1999

Reading ability, education, and cognitive status assessment among older adults in Harlem, New York City.

OBJECTIVES: This study examined reported level of education and current reading ability as predictors of cognitive status among older African Americans in central Harlem, New York City. METHODS: A probability sample of 164 noninstitutionalized older African Americans was assessed. Mini-Mental State Examination (MMSE) scores were regressed on education and reading ability measures. RESULTS: Reading ability and educational attainment were significant, independent predictors of MMSE performance. Within any level of education, subjects whose grade-equivalent reading ability exceeded reported level of education scored significantly higher on the MMSE. CONCLUSIONS: Reading ability may be useful in interpreting the results of cognitive screening among low-educated and minority groups.

Black or African American↗

PubMed2005

Physical health and mental disorder in elderly suicide: a case-control study.

The psychological autopsy method was used to study 95 cases of suicide. Ninety-five comparison subjects matched for gender, age, region, and date of death were selected from the death register. This study showed that suicide cases did not differ from controls with regard to the number of chronic health problems and, compared to the suicide cases, the controls had less functional autonomy six months prior to death. If minor and sub-threshold depression cases were included, 74.7% of the suicide cases would have been considered as having a mental health disorder compared to 12.6% in the control group. When the effect of other co-variables were controlled for, multivariate analysis showed that suicide cases and controls did not differ according to marital status, education, income, and living arrangement. Furthermore, suicide cases were no more likely than controls to seldom meet with family members or friends or to have been isolated during the six-month period preceding their death. Our findings suggest that detection of psychiatric disorders, mainly depression, must be included in late life suicide prevention strategies.

Aged↗

PubMedDate not supplied

A cross-sectional study on factors including HIV testing and counselling determining unsafe injecting practices among injecting drug users of Manipur.

In India, a steep increase in the prevalence of HIV (0% to 50% within six months) among the IDUs has been reported in Manipur, a north eastern state in 1990. In spite of large scale intervention program like educational campaign and widespread voluntary HIV testing in this state, the infection has quickly spread to the heterosexual population at large. The determinants of risk taking behaviors like sharing of unclean needle among the IDU population has been explored in this paper. A cross sectional study has been carried out among all of the 488 IDUs who attended any detoxification centers and prison during last two years at Imphal, the capital city of this state. Self reported behaviors based on the pre-scheduled interview were recorded and participation rate was satisfactory. The data was compared to a similar survey carried out by us in 1990. Although there has been decline in risk behavior among the IDUs, a logistic regression analysis reveals that unsafe needle sharing behavior is not influenced by the knowledge on HIV transmission, educational status or history of HIV testing or serostatus of the individual. The limitation of cross sectional nature of the study, bias due to collection of data in prison, self reported behavior, possible differences with street samples of the addict are discussed.

AIDS Serodiagnosis↗

PubMed2006

Return to work among sickness-absent Danish employees: prospective results from the Danish Work Environment Cohort Study/National Register on Social Transfer Payments.

This study investigates the determinants within socio-demography, health behaviour, employer characteristics, and psychosocial and physical work environment for return to work. In 2000, a total of 5357 employees were interviewed regarding age, gender, family status, education, health behaviour, employer characteristics and work environment. They were followed in a national register for 18 months in order to identify subjects with 2 weeks or more of sickness absence. They were followed for an additional 12 months in order to establish associations between baseline measurements and time to first return to work. A total of 930 (17.4%) employees experienced sickness absence in the 18 months after baseline. During the 12-month follow-up, 856 (92.0%) returned to work, the mean absence period being 6.6 weeks. Prolonged time to first return to work was associated with female gender, increased age, no post-school education, being employed by a public employer, working at a workplace with 20 or more employees, high emotional demands in work, high job insecurity and sedentary work. There were no associations between health behaviour variables and return to work. The study indicates a potential for promoting return to work through interventions targeting emotional job demands, job insecurity and decreasing the risks associated with sedentary work.

Denmark↗

PubMed2006

Population trends in leisure-time physical activity: Minnesota Heart Survey, 1980-2000.

PURPOSE: Twenty-year trends in lifestyle (leisure, household, and transportation related) physical activity and leisure-time physical activity (LTPA) were evaluated in the Minnesota Heart Survey (MHS), a population-based surveillance study to monitor trends in cardiovascular risk factor levels among residents of the Minneapolis-St. Paul metropolitan area. METHODS: The Minnesota LTPA questionnaire was administered to adult participants in one of five cross-sectional MHS surveys conducted in 1980 (N = 1626), 1985 (N = 2292), 1990 (N = 2552), 1995 (N = 2432), and 2000 (N = 3089). Occupational activity was queried in 1980, 1995, and 2000. Age-adjusted, gender-specific geometric means of lifestyle physical activity and LTPA and of light-, moderate-, and vigorous-intensity activities were calculated for each survey. The proportion of adults participating in regular physical activity for 30 and 60 min x d(-1) was reported. RESULTS: Male gender, younger age, higher educational status, and employment were characteristic of greater participation in physical activity. Daily energy expenditure from lifestyle physical activity and LTPA increased between 1980 and 2000 in both genders, and workplace activity decreased. Using direct questions, the prevalence of men and women participating in 30 or more minutes of physical activity at least five times per week ranged from 8 to 12%, with no time trend. Only 1% of participants participated 60 min daily. Overall, BMI was 1-2 kg x m(-2) lower among individuals who participated regularly in physical activity. CONCLUSIONS: Although energy expenditure was lower than national recommendations, greater physical activity was associated with lower body mass. Public health strategies are needed to facilitate participation in physical activity, especially for women, elderly, and less educated individuals.

Adult↗

PubMedDate not supplied

Socio-economic profile and performance of CHVs in Gujarat: implications for selection and support.

What type of person should be selected as Community Health Volunteer (CHV) has been a matter of debate. This study relates socio-economic characteristics--age, sex, marital status, education, caste, organisation membership and landownership--with performance on direct patient care, mother and child health, family welfare and environmental sanitation. The paper further suggests strategies for selection, training and support in case of CHVs whose performance is poor.

Community Health Workers↗

PubMed1992

Interictal depression in epilepsy.

The relation between depression and epilepsy was evaluated in 96 epileptic out-patients. We found that 50% of epileptic patients fulfilled the DSM-IIIR criteria for depression. The Hamilton Rating Scale for Depression, the Beck Self Depression Inventory and the Zung Anxiety Scale were also used in all patients. The patients with partial seizures with complex semiology (CPS) were more depressed than the patients with primary generalized epilepsy and with partial seizures with elementary semiology. A significant increase in the level of anxiety was also found in the group with CPS compared to the other two groups. No correlations were noted between severity of depression and duration of epilepsy, seizure frequency, socio-economic status, education, and family history of depressive illness. No relationship was observed between anticonvulsant drug levels and depression. We failed to confirm an association between side of epileptic lesion and severity of depression. We suggest that depression in epileptic patients does not represent a psychological reaction to a particular cognitive or physical impairment, but is in some way related to the type of epilepsy.

Adult↗

PubMed1998

Female circumcision and determinants in southern Nigeria.

One hundred and ninety two postnatal women and ninety five newly born baby girls were prospectively investigated at the six weeks postnatal clinic of the department of obstetrics and gynaecology of the University of Benin Teaching Hospital, Benin City, Nigeria between January 1, 1996 and April 30, 1996. Circumcision was clinically verified in 65% of the mothers and in 38% of the baby girls. The decision to circumcise the babies was taken in over 90% of cases by husbands even though this was opposed by wives in 19% of cases. Significantly more circumcised than uncircumcised baby girls had circumcised mothers (P < 0.01) and maternal low educational status was significantly related (P < 0.01) to the tendency to circumcise the babies. There was lack of antenatal counselling of most mothers. It is concluded that while the incidence of female circumcision may be declining, attention needs to be focused on proper community enlightenment as well as the role of the male in the decision to circumcise daughters.

Circumcision, Male↗

PubMed2003

The personality and quality of life in HNSCC patients following treatment.

The aim of the present study was to investigate the association between self-reported quality of life (QoL) and personality in successfully treated primary head and neck squamous cell carcinoma (HNSCC) patients. We determined QoL using the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) C30/H and N35, and personality by the Eysenck Personality Inventory (EPI). All patients younger than 80 years who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who had survived until 1999, were sampled. 96 patients (a 90% response rate) were included. Questionnaires were also mailed to all Norwegian laryngectomised patients; 104 patients returned the questionnaires (a 50% response rate). The neuroticism scores were test re-test reliable as determined by the neuroticism scores measured at the primary HNSCC diagnosis for a sub-sample (N=22) of the included patients. High neuroticism was associated with a low QoL in both patient samples. The neuroticism score was associated with the QLQ-C30 scales (common variance: 17-25%) and all QoL scores in the laryngectomised group (common variance: 11-25%), and the H and N35 symptom scores in the laryngectomised sample. The associations could still be shown when adjustments were made for gender, age, marital status, educational level, number of children and level of treatment. Extraversion was associated with general QoL, physical and emotional scores in the HNSCC patient sample. Radiation therapy in the HNSCC sample was associated with the H and N35 symptom scores, but different ones to those associated with neuroticism. In conclusion, high neuroticism, but not extraversion, is associated with a lowered QoL.

Adolescent↗

PubMed1995

Relationship between perceptions of physical activity and health-related fitness.

OBJECTIVE: To assess perceptions of fitness, intensity and frequency of habitual physical activity as predictors of cardiovascular function, metabolic health and obesity. DESIGN: Cross-sectional correlational, with covariance adjustment of data for age and socio-economic status. SETTING: An urban community of some 250,000 people. PARTICIPANTS: Convenience sample of healthy but relatively sedentary subjects, 172 males and 178 females aged 14-68 years. MEASURES: Self-reports of perceived fitness, habitual activity, intensity and frequency of exercise; standard laboratory tests of cardiovascular function (resting heart rate, PWC 150/kg, systolic and diastolic blood pressure), metabolic health (blood glucose, total cholesterol, HDL-cholesterol, triglycerides and uric acid), obesity (body mass index, skinfolds, hydrostatic body fat, and abdominal circumferences) and socio-economic status (education, job classification and income). RESULTS: In men, the strongest associations of fitness markers were with peer comparisons of fitness and activity. In women, such comparisons also yielded significant positive associations, but the most consistent relationships of fitness were with Godin questionnaire ratings of sweat-inducing and frequent heavy activity. Perceptions of intense activity were associated more with cardiovascular than with metabolic health. Perceptions of frequent activity (peer activity ratings, occupational walking, and the number of activities reported) were associated with control of body fat, and to a lesser extent with cardiovascular function, but were unrelated to markers of metabolic health. CONCLUSION: Perceptions of personal fitness, intensity and frequency of habitual activity are all associated with markers of health-related fitness after allowance for effects of gender, age and socio-economic status. The public should thus be encouraged to pursue activity that they perceive as frequent, intense and improving their fitness.

Adolescent↗