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Summary health statistics for the U.S. population: National Health Interview Survey, 2001.

OBJECTIVES: This report presents health statistics from the 2001 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's National Center for Health Statistics. Household interviews were completed for 100,760 persons living in 38,932 households, reflecting a household response rate of 89%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2001. About 33 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. Persons with the least education and the lowest incomes were the most likely to be limited in their ability to work. About 6% of children received special education or early intervention services. The three leading causes of medically attended injury and poisoning episodes were falls, transportation, and overexertion. Among persons under age 65 years, about 39 million (16%) 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↗

[Prevalence of smoking among women in reproductive age in Puerto Rico].

The prevalence of smoking in Puerto Rican women was estimated on the basis of data from 3,157 women 15 to 49 years of age who had been surveyed in the 1982 Evaluation of Fertility and Family Planning in Puerto Rico. The weighted prevalence was 15.5%, with a 95% confidence interval of 13.8 to 17.1. The prevalence varied by age group, education, marital status, place of residence at age 15, and consumption of alcohol. The prevalence of smoking increased in successive birth cohorts while the mean age at initiation of the habit tended to decline. The data suggest that in Puerto Rico smoking is on the rise among younger women.

Adolescent↗

A population-based study of the waiting times for prostatectomy in Ontario.

INTRODUCTION AND OBJECTIVE: Despite the high incidence of prostate cancer in Canada, there is currently limited information describing how these patients are being managed. The aim of this study was to review the surgical waiting times for radical prostatectomy in Ontario, utilizing existing population-based cancer databases, and to describe factors associated with prolonged waiting times. METHODS: This is a retrospective, population-based, observational study of men diagnosed with prostate cancer in Ontario between 1980 and 2000. The sources of data include the Ontario Cancer Registry linked to hospital discharge data, as well as census data from Statistics Canada. Study variables include age, county of residence, teaching hospital status, hospital surgical volume, area-level median household income and cause-specific survival. Waiting times were compared across study variables using univariate and graphical methods. Survival was compared across geographic regions with differing average wait times. RESULTS: We identified 9524 men treated with radical prostatectomy in Ontario over the study period and found the percentage of all patients with the disease who were treated surgically increasing from 3% to 20% over the last 2 decades. The overall time to prostatectomy has almost doubled with a median waiting time of 55 days in earlier eras to 91 days in 1996-2000. A few counties had significantly different wait times, whereas age and socio-economic factors were not associated with wait times across most eras. In the most recent eras, acute care hospitals and hospitals with higher surgical volumes had significantly higher waiting times (up to 20 days longer in 1996-2000, p<0.0001). Patients living in regions with the shortest wait times had statistically significant worse survival (p=0.02), implying that triaging has a greater impact than the potential effect of prolonged waits. CONCLUSIONS: The observed increases in waiting times for radical prostatectomy from this study are similar to the known increases in waiting times for radiotherapy. This increased time to treatment is an illustration of the stress on the health care system in Ontario.

Aged↗

Summary health statistics for the U.S. population: National Health Interview Survey, 2003.

OBJECTIVES: This report presents both age-adjusted and unadjusted health statistics from the 2003 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 2003, household interviews were completed for 92,148 persons living in 35,921 households, reflecting a household response rate of 89.2%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2003. 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 41 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↗

Blunted seasonal variation in serum 25-hydroxy vitamin D and increased risk of osteomalacia in vegetarian London Asians.

Serum 25-hydroxy vitamin D levels were measured in 297 adult Asians and 68 white subjects at different times of year and seasonal variation compared between subjects grouped according to ethnic origin, religion and dietary habit. A sub-group of Asians with symptoms and biochemical changes suggestive of osteomalacia underwent bone biopsy, and static bone histomorphometry was performed. Histological osteomalacia was detected in 15 Asians and borderline changes in 13. The majority of these cases were among vegetarian Hindus. Significant seasonal variation in 25-hydroxy vitamin D was observed in all groups, but with lower peak and trough levels among Asians, and especially the Hindus and vegetarian Asians. Summer rises in 25-hydroxy vitamin D levels were blunted among Hindus and vegetarian Asians, compared to whites, Muslims and non-vegetarian Asians. Vegetarian Asians had significantly lower serum calcium and higher PTH levels than non-vegetarians, but multivariate analysis indicated that this was an effect of osteomalacia, not vegetarianism. We conclude that solar exposure has a significant effect on vitamin D status in Asians resident in London. Non-vegetarian Asians have similar rise and peak levels to whites, but those taking a vegetarian diet (in particular, Hindus) have an impaired seasonal rise in 25-hydroxy vitamin D levels, and are at particular risk of metabolic bone disease. This effect did not appear to be mediated through secondary hyperparathyroidism consequent on a vegetarian diet.

Adult↗

Tobacco smoking in India: prevalence, quit-rates and respiratory morbidity.

BACKGROUND: Population prevalence of tobacco smoking especially with reference to detailed habits such as the amount smoked, the smoking forms, quit-rates and relationship with demographic variables were studied at four different centres in India along with the study on epidemiology of asthma and chronic obstructive pulmonary disease. METHODS: The study population included adults of over 15 years of age selected with two-stage stratified random sample design. A specifically designed questionnaire was used for the study. RESULTS: There were 11496 (15.6%) ever smokers in the study sample of 73605 subjects. Among 37682 males, 10756 (28.5%) were ever smokers and among 35923 females, 740 (2.1%) were ever smokers. Bidi was the commonest form of smoking, more so in the rural areas. The mean number of cigarettes/bidis smoked per day was 14 (+/- 11.5) and the mean age of starting smoking was 20.5 (+/- 20.0) years. Increasing age, low socio-economic status and rural residence were important factors associated with smoking. Vigorous anti-tobacco measures under the tobacco control programmes yielded only a quit-rate of 10 percent. Nearly 14% of ever smokers had some respiratory symptoms. CONCLUSIONS: A substantial proportion of population in India has current or past smoking habit with higher prevalence among males than females. The quit-rates have been low in spite of the various anti-tobacco measures. There is a significant respiratory morbidity associated with smoking.

Adolescent↗

Disparity in maternal mortality in New York City.

OBJECTIVE: To describe maternal deaths and 10-year trends in maternal mortality in New York City. METHODS: All maternal deaths reported by surveillance of vital records (bearing ICD-9 codes 630-676) in New York City between 1989 and 1998 were studied. Were viewed death certificates and medical and autopsy records to collect age, race/ethnicity, country of birth, marital status, education level, residence at time of death, cause of death, and outcome of pregnancy. Trends analysis for maternal mortality rates was conducted, stratified by race. We conducted univariate and multivariate analysis to identify risk factors for maternal death. RESULTS: Two hundred forty-three maternal deaths were reported, for an average maternal mortality rate (MMR) of 18.4 deaths per 100,000 live births during this period. Although the overall MMR decreased from 17.4 in 1989 to 13.7 in 1998, the MMR varied widely during the period with a non significant trend (x2 for trend 2.09, p=.15). However, the individual MMR for whites and blacks decreased significantly from 1989 to 1998. The black-white MMR ratio remained high throughout this period and varied from 2.2 in 1994 to 14.8 in 1998. Women who were 35 years of age or older or non-Hispanic black had an increased risk of a pregnancy-related death. The leading causes of death were hemorrhage, embolism, and infection. CONCLUSION: Racial disparity in maternal mortality is a cause for concern in New York City. Further studies of maternal mortality are needed to develop interventions to reduce the MMR and the black-white gap.

Black or African American↗

Greek medical papyri from the Fayum village of Tebtunis: patient involvement in a local health-care system?

The Greek papyri of medical content from Tebtunis are conspicuous for their quantity and quality, when compared with neighbouring villages. By isolating another feature in which Tebtunis is also unique--namely, in the relatively large number of those of privileged status who maintained residences and left important documents in the village, it would appear that these outsiders were instrumental in interesting the local priests in sophisticated Greek medicine and in bringing medical texts into the village. Tebtunis may thus provide an ancient example of patients influencing the health care available to them and their families when resident in the village.

Delivery of Health Care↗

Diet, tobacco use, and fatal prostate cancer: results from the Lutheran Brotherhood Cohort Study.

A cohort of 17,633 white males age 35 and older responded to a mailed epidemiological questionnaire in 1966 and was followed until 1986 to determine the risk of cancer associated with diet, tobacco use, and other factors. During the 20-year follow-up, 149 fatal prostate cancer cases were identified. Relative risks for prostate cancer were significantly elevated among cigarette smokers (relative risk, 1.8; 95% confidence interval, 1.1-2.9) and users of smokeless tobacco (relative risk, 2.1; 95% confidence interval, 1.1-4.1). No significant associations were found with frequency of consumption of meats, dairy products, fruits, or vegetables. There were no overall significant associations between consumption of vitamin A from animal sources (retinol) and provitamin A from plant sources (carotene) and risk, but positive trends were seen for ages under 75, while inverse associations were found at older ages. Beverage consumption, including drinking coffee and alcohol, was unrelated to risk. Marital status, education, rural/urban status, and farming residence were also unrelated to the risk of fatal prostate cancer. The findings add to limited evidence that tobacco may be a risk factor for prostate cancer, but fail to provide clues to dietary or other risk factors.

Adult↗

Respiratory health status of children in the eastern Transvaal highveld.

A study was undertaken to determine if there were detectable effects on the respiratory health status of children resident in the eastern Transvaal highveld as a consequence of their exposure to community air pollution, comparing them with children in areas ostensibly less polluted. A prevalence study was conducted in white schoolchildren from 11 schools in the eastern Transvaal highveld (1,031 children) and from 11 schools in non-polluted towns in the Transvaal (978 children). A questionnaire was completed by each child's mother, and height and weight were measured and spirometry recorded on a vitalograph. Cough, wheeze, asthma and chest illnesses were more frequently reported from polluted areas compared with non-polluted areas, taking into account parental smoking and home cooking fuel (odds ratios 1.34, 1.20, 1.15 and 1.88, respectively). After correcting for age, children in the polluted area were 0.83 cm shorter (P = 0.035). However, there were no significant differences in forced vital capacity and forced expiratory volume in 1 second after standardising for height, age, parental smoking and home cooking fuel. We conclude that, in children, exposure to pollution in the eastern Transvaal highveld may cause respiratory symptoms and chest illness and may affect height but does not measurably affect lung function, as assessed by spirometry.

Air Pollution↗

[Factors associated with cancer of the prostate].

An epidemiological case-control study was performed to know the factors involved in the development of prostatic cancer. Ninety patients diagnosed of prostatic cancer in La Paz Hospital (Madrid) from January, 1981 to December, 1987, comprised the study group. The controls were 180 male patients from the same hospital and with no personal or familial antecedents of urologic disease or malignant tumours. The cases and controls were matched by age, and year of admission to the hospital. The results of the study revealed that the disease is strongly associated to familial antecedents of prostatic cancer. The risk for the patients with these antecedents is 3.14. The disease was statistically associated to a fatherhood of more than 5 children. No association between the disease and antecedents of tonsillectomy, rheumatic fever, educational level, place of residence, or marital status was found.

Aged↗

[Possibility of using immunologic indicators in evaluating the effect of pesticides on the body].

The modern problem of pesticide-related pathogenic body effect has been studied from different points of view. However, some medical aspects of pesticide-induced diseases, primarily their effect on the immune status, remain insufficiently explored. The study is designed to analyze pesticide effect on basic indicators of humoral and cellular immune factors and also to develop a new principle for assessing their exposure according to the degree of immune changes in those exposed to pesticides. Proceeding from the study results it is possible to conclude that under long-term exposure to pesticide microdoses the human body undergoes complex changes: there develops autoimmunization accompanied by the manifestation of antitissue autoantibodies, reduction of serum complement activity, relative content of T-lymphocytes and elevation of the level of B-lymphocytes. Toxicant-related body sensitization and decline in immuno-resistance can serve as the main cause for the deterioration of health status of the residents of the rural areas characterized by higher chemical exposure.

Adult↗

Human monkeypox: secondary attack rates.

Data on human monkeypox collected in Zaire during the six years 1981-86 were analysed to assess the extent of interhuman transmission of monkeypox virus. Among the 2278 persons who had close contact with 245 monkeypox patients infected from an animal source, 93 fell ill and were presumed to have been infected from the known human source: 69 of these were spread in the first generation, 19 in the second generation, and the remaining five cases in the third and fourth generation.The secondary attack rates were correlated with the age, sex, place of residence, and vaccination status of the contacts. There was an overall 3% probability of becoming ill following infection from a known human source. The affected household was the main focal point for interhuman transmission of monkeypox virus. The highest attack rate (11.7%) occurred among unvaccinated household contacts in the age group 0-4 years. However, the majority of susceptible persons who had been close to patients in the confined space of poorly ventilated huts failed to develop illness. There was no evidence of an increase in the secondary attack rate between 1970-80 and 1981-86.The inefficient spread from person to person, even in conditions of maximum exposure, supports the concept that monkeypox virus is poorly adapted for sustained transmission between humans and that such transmission does not pose a significant health problem.

Adolescent↗

Mother-to-child transmission of hepatitis B virus in a semirural population in Egypt.

A follow-up study for one year was made on 35 babies born to HBsAg positive mothers in a semirural population in Egypt. Five of 21 babies (24%) showed HBsAg in the umbilical cord blood and remained positive throughout the observation period. At 3 months, eight of 37 babies (23%) were HBsAg + ve. At 6 months, 13 of 35 babies (37%) were HBsAg + ve and they were also still found positive at 12 months. None of 30 babies born to HBsAg-ve mothers developed antigenaemia throughout the observation period. Factors which significantly contributed to transmission were maternal educational level, family socio-economic standard, family residence, maternal e/anti-e status, and maternal schistosomal infestation. Factors which did not significantly affect transmission were maternal age, maternal parasitic non-schistosomal infestations, maternal transaminases level, order of the child in the family, and type of child feeding. Of particular note, four of five babies (80%) born to HBsAg + ve mothers who as well had schistosomiasis were HBsAg + ve throughout the observation period.

Adolescent↗

Early activation for acutely ill elderly patients.

In order to describe both the process and the impact of introducing a program of early activation for acutely admitted elderly patients in medical wards, two populations, one before and the other after the intervention of the program, were followed up. The program was implemented in cooperation with the nursing staff, who were integrated in the rehabilitation work. Population I (219 admissions) was collected in 1981 and Population II (272 admissions) during a corresponding period in 1983. Survival, type of residence and ADL status 5 months after hospital admission were recorded as outcome measures. There were no differences between 1981 and 1983. In 1983 the mean length of stay was 4.7 days shorter than in 1981. The program cannot be shown to have caused the difference in length of stay. The study shows that such a program of early activation was easy to apply in clinical practice for aged and disabled patients in general medical wards.

Activities of Daily Living↗

The declining length of hospitalization for tubal sterilization.

We analyzed factors affecting the length of hospital stay for tubal sterilization in 1970 and 1975, using data from the National Center for Health Statistic's Hospital Discharge Survey. The average hospital stay for tubal sterilization declined from 6.5 nights in 1970 to 4.0 nights in 1975. Pregnancy status, region of residence, and race were important determinants of the length of hospital stay. One technological innovation, the use of the laparoscope for tubal sterilization, accounted for 39% of the total length-of-stay reduction from 1970 to 1975. General changes in medical care from 1970 to 1975, combined with the introduction of laparoscopy, averted 1,363,000 nights of hospitalization for tubal sterilization in 1975. Conservatively, this resulted in a savings of more than $200 million. About $80 million of this savings was directly attributable to laparoscopy. Even greater savings could have been achieved if sterilization techniques requiring shorter hospital stays had been more widely used.

Black People↗

A study of humanism in family physicians.

The purposes of this study were to examine humanism as exhibited in physicians and to develop and standardize an instrument measuring humanism in physicians. This study had four specific objectives: (1) to determine whether family practice residents are more humanistic than internal medicine and surgery residents, (2) to determine whether there is a difference in the level of humanism in residents in different years of training, (3) to determine the relationship of demographic characteristics to level of humanism, and (4) to determine the relationship of family practice residency characteristics to level of humanism. The Physician Humanism Scale was developed, pretested, modified, and then administered to a sample (600) of family practice, internal medicine, and surgery residents. The study identified that family practice residents are significantly more humanistic than internal medicine and surgery residents, although no difference in level of humanism was identified according to year in residency. Significant relationships were identified between humanism and sex, race, age, marital status, and college major. Residency characteristics significantly related to humanism were numbers of residents, full-time faculty, nonphysician faculty, and associated residencies; hospital size; and moonlighting policy.

Analysis of Variance↗

Risk factors for sexually transmitted disease amongst men in Harare, Zimbabwe.

A cross sectional survey was carried out among adult males attending a municipal polyclinic and two private practitioner surgeries in a Harare high density suburb, in order to identify risk factors for Sexually Transmitted Disease (STD). One hundred and twenty subjects participated, of whom 83 were cases (those with STD in the past six months) and 37 were controls (those with no STD). No association of STD was found with marital status, place of residence of wife, age, level of education or employment. STD was strongly associated with alcohol consumption (Odds Ratio = 7,1 [95 pc CI: 2,8-18,7]). These results strongly suggest that alcohol consumption is an important risk factor for STD. Further work is needed to explore the relationship between alcohol consumption and high risk sexual behaviour, and to test the impact of programmes aimed at targeting the reduction of alcohol use on the transmission of HIV infection.

Adult↗