Health status of Canadian-born and foreign-born residents.
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Adolescent↗
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Women's postpartum stress, social support, and health status.
The purpose of this study was to examine women's postpartum stress, social support, and health status at different places of residence during their postpartum periods. Using proportional stratified quota sampling of hospitals by birth rate from clinics and hospitals in Kaohsiung City in southern Taiwan, postpartum married women were recruited for the study. The results show that the home of the women's parents (25.7%), her own home (with parents-in-law; 23.8%), and her own home (without parents or parents-in-law; 23.1%) were the main places of residence for women during the postpartum period. In addition, postpartum women's mean scores for postpartum stress were low. In contrast, the mean scores for social support were high, although they did not differ significantly for the respective places of postpartum residence. Furthermore, significant differences were not found in these women's postpartum health status at each of the places of postpartum residence.
Depression, Postpartum↗
Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient?
OBJECTIVE: Malnutrition is highly prevalent in hospitalized patients and is often not identified by the medical staff. Clinical nutrition and nutritional assessment are often neglected components of the curriculum of medical schools. The effect of instruction of nutritional assessment early in medical school on nutritional practice in clinical training is unknown. Four years after the introduction of nutritional assessment in the medical school curriculum, we assessed the knowledge of medical students and residents of nutritional assessment and the practice of this clinical skill in hospitalized medical patients. METHODS: We determined the nutritional status of 69 patients on a general medical ward within 10 d of their hospital admission. Hospital records were reviewed to determine the documentation of nutrition-related issues and practices. A questionnaire was then administered to the housestaff to determine their knowledge of assessment of nutritional status. RESULTS: Significant malnutrition was found in 69% of patients. Only one patient was identified as being malnourished by the housestaff. References to nutritional status were recorded in two patient charts. History of weight loss, appetite status, current oral intake, and functional status were recorded for fewer than 33% of patients. Although measurements of visceral protein stores (albumin and prealbumin) did not correlate with nutritional status, medical students and residents considered these to be the best markers of nutritional status. CONCLUSIONS: Malnutrition is common in hospitalized patients. Instruction of second-year medical students in assessment of nutritional status does not result in improved knowledge or practice of nutritional assessment in the clinical training years as medical housestaff. Additional instruction in nutritional assessment during clinical training needs to be emphasized. Hospitals need to develop standardized protocols for assessment of nutritional status.
Adult↗
End-of-life care in nursing homes: residents in hospice compared to other end-stage residents.
OBJECTIVE: To compare residents in hospice care at admission to the nursing facility to end stage residents not in hospice at admission. DESIGN AND METHODS: We analyzed 18,211 admission assessments recorded in the Minimum Data Set (MDS) during the year 2000 throughout the United States for residents classified as having an end-stage disease (6 or fewer months to live). Fifty-nine percent (n = 10,656) of these residents were in hospice care at the time of their admission assessment. We used these MDS admission assessments to compare residents in hospice care to other end-stage residents not in hospice for demographic characteristics, health status, and treatments. RESULTS: Hospice residents at admission were significantly more likely to be female, older, white, and widowed than other end-stage residents at admission. There were significant differences between hospice residents and other residents at end stage in the use of advanced directives at admission. Hospice residents at admission experienced significantly more frequent and more intense pain than other end-stage residents at admission, while these hospice residents also showed greater impairment in cognitive ability and physical function. While cancer was the most common disease among these end-stage residents, it was significantly more prevalent among hospice residents. IMPLICATIONS: Many end-stage residents may not be receiving adequate palliative care in nursing facilities; further study of this is warranted. The MDS should be revised to record minimum standards for palliative care with or without the use of hospice to improve end-of life care in nursing facilities.
Activities of Daily Living↗
[A preliminary analysis of unmarried mothers who were heads of households in Brazil during 1970 and 1980].
"This paper reports on an attempt to use census data from Brazil in 1970 and 1980 to investigate a rise in household headship by unmarried mothers 15-49.... Demographic analysis can be useful in decomposing the change into that due to a changed propensity of women 15-49 years of age to be unmarried, to have children if unmarried, and to head their own household if an unmarried mother. This was further analyzed in terms of age, marital status (whether single, divorced/separated or widowed), region of residence, and urban-rural status....However, the research encountered data problems that make firm conclusions impossible...." This is a translation of a paper originally presented at the 1992 Annual Meeting of the Population Association of America. (SUMMARY IN ENG)
Age Factors↗
Lead levels in human deciduous teeth in Tennessee.
Deciduous teeth were analyzed by atomic absorption spectroscopy for lead content to ascertain the extent of lead exposure in certain areas in Tennessee. The data were analyzed to clarify the relationships between tooth lead content and race, sex, age, tooth type, economic status, and place of residence. Results indicated that blacks had slightly higher lead concentrations than whites; however, the age and sex of the person or the type of tooth analyzed had little effect upon the lead content. The major factors were shown to be economic status and, indirectly, place of residence.
Black or African American↗
Perceptions of family practice residents regarding health care and poor patients.
The purpose of this study was to assess residents' beliefs about the poor. Residents from eight different Ohio residency programs completed the questionnaire (N = 130). No significant differences were found in beliefs about the poor based on resident age, year of residency training, size of the community in which the resident was raised, and percentage of low-socioeconomic-status patients cared for. Most residents perceived the welfare system as lacking; 83 percent agreed the poor are caught in a "cycle of poverty," 82 percent agreed welfare benefits cause the poor to be dependent upon the system, and 48 percent believed indigent women become pregnant and have babies so they can collect welfare support. Conversely, only one in four residents believed that most poor people become poor as a result of lack of effort on their part, and one in five believed that society is coddling the poor. The majority of residents believed that poor patients are more likely than others to miss appointments without canceling (73 percent), more likely to be late for appointments (51 percent), and less knowledgeable about their illnesses (80 percent). One in four residents believed that poor patients tend not to appreciate the work of physicians and nurses, and 43 percent claimed that the poor are more difficult patients. The majority of residents believed that the poor are unlikely to practice preventive health behaviors (72 percent) or to be compliant with their medical regimen (60 percent). Finally, 41 percent believed that poor patients usually care less than others about their own health status.
Adult↗
Changes in nutrition among residents and refugees in Sarajevo during the war.
OBJECTIVE: To assess how food shortage has been reflected in changes in nutritional status and dietary intake of resident and refugee populations in wartime Sarajevo. DESIGN: Longitudinal observations were carried out on residents (who stayed in their homes) and refugees (living in collective centres). Three out of four municipal areas of Sarajevo were covered in the sample and households and collective centres in close proximity to the homes of fieldworkers were selected. The same households were visited in October 1992-March 1993 and November 1993-January 1994. SETTING: The study took place in besieged Sarajevo. SUBJECTS: In the first round 362 households (170 resident and 192 refugee) were visited and in the second round 324 households (146 resident and 178 refugee) were visited. INTERVENTIONS: Nutritional information was gathered through anthropometric measurements, medical examination and questionnaires which included a seven day dietary recall. RESULTS: Nutritional status was assessed by calculating body mass index (BMI) (weight/height2) in adults and weight for age percentiles in children (2-18 years of age). Undernutrition in adults was defined as BMI < 18.5 and in children as weight for age < 25th percentile. Results from the first round of data collection showed a higher level of undernutrition among refugees (15.0%) compared to residents (5.3%). The second round revealed higher levels of undernutrition among residents (8.1%) than refugees (7.0%). Daily energy intake in the first round met only half recommended dietary allowances for the former Yugoslavia which is 2700 kcals per day. Refugees were found to consume slightly higher quantities of energy (1500 kcals) compared to residents (1272 kcals). In the second round, energy intake had increased both among refugees (1832 kcals) and residents (1630 kcals). CONCLUSIONS: The population of Sarajevo have been forced to eat a monotonous diet during the war which is deficient both in quantity and quality. Nevertheless the nutritional status of the resident and refugee populations has been maintained. Dietary intake was found to be low but this may have been partly due to under-reporting. The accuracy of data obtained through dietary intake surveys in emergency conditions may be questionable.
Adolescent↗
Mortality of a residential cohort exposed to radon from industrially contaminated soil.
A historical cohort mortality study was conducted in three neighborhoods of Essex County, New Jersey, to investigate the mortality patterns of persons who had inhabited 45 homes documented to be contaminated by radon gas emanating from radium processing waste. Residency history and vital status were collected for 752 persons, comprising 91% of the subjects enumerated who had resided in the index homes for at least one year during the years 1923-1983. Standardized mortality ratios (SMR) were used to compare the death rates of the study group with the death rates of the United States and New Jersey. While there were no statistically significant excesses of lung cancer for the cohort or its subgroups, an elevated mortality rate for lung cancer was found for white males in the comparison of lung cancer mortality rates in the United States (SMR = 1.5, 95% confidence interval (CI) 0.7-2.7) and New Jersey (SMR = 1.7, 95% CI 0.8-3.2). No excess of lung cancer was observed in females or nonwhites. The small size of the cohort and the inability to collect smoking histories or complete occupational data limited the study. Nevertheless, the degree of excess lung cancer among white males was in agreement with both the attributable and relative risk estimates per unit of exposure derived for radon from mining studies.
Cardiovascular Diseases↗
Physical activity behaviors in lower and higher socioeconomic status populations.
Few data on physical activity habits among populations of low socioeconomic status have been published. The authors studied physical activity habits--leisure-time physical activity, job-related physical activity, household physical activity, and walking--among 172 lower socioeconomic status women and 84 lower socioeconomic status men and compared their habits with those of 208 higher socioeconomic status women and 95 higher socioeconomic status men. All subjects resided in the greater Pittsburgh, Pennsylvania, area. Data collection occurred throughout 1986. Lower socioeconomic status women, the least active group, averaged 1,536 +/- 1,701 minutes/week (+/- standard deviation) of total physical activity, whereas higher socioeconomic status women, the most active group, averaged 2,079 +/- 1,807 minutes/week (p less than 0.0001). Higher socioeconomic status men averaged 1,952 +/- 1,799 minutes/week, and lower socioeconomic status men averaged 1,948 +/- 1,916 minutes/week. Higher socioeconomic status women spent significantly more time each week in leisure-time physical activity, job-related physical activity, and household physical activity than did lower socioeconomic status women. Lower socioeconomic status men spent significantly more time each week walking and doing household chores, whereas higher socioeconomic status men tended to be more active in leisure-time physical activity. These data suggest important quantitative and qualitative differences in physical activity among population subgroups. In view of the important role of physical activity in promoting physical and mental health, reasons for the differences among groups of varying socioeconomic status must be examined and elucidated.
Adult↗
Individual health status and racial minority concentration in US states and counties.
OBJECTIVES: We examined whether the positive association between mortality rates and racial minority concentration documented in ecological studies would be found for health status after control for race/ethnicity, socioeconomic status, and region of residence. METHODS: We estimated least squares and probit models using aggregate and individual health status data from the 1995, 1997, and 1999 versions of the Current Population Survey merged with data from the US Bureau of the Census regarding state- and county-level racial minority concentration. RESULTS: Except in the case of older Whites, racial minority concentration was not associated with health status after control for individual characteristics and fixed regional factors. CONCLUSIONS: Racial minority concentration may not be a determinant of individual health; differential migration patterns may explain the anomalous result for older Whites.
Adult↗
Guatemalan human onchocerciasis. I. Systematic analysis of patient populations, nodular antigens, and specific isotypic reactions.
The population from five Guatemalan plantations in areas endemic for onchocerciasis was surveyed, and 1032 individuals were recruited to participate in our study. From physical examination, past clinical history (5 to 8 yr), laboratory evidence and sample availability, a group of 778 long term residents with confirmed disease status were selected for detailed examination. We were able to identify 268 long term residents of endemic areas who had never been infected, 44 of these are from hyper- and mesoendemic areas. The 44 uninfected individuals from the hyper- and mesoendemic areas, because of their considerable exposure to this disease, were classified as "putatively immune." Intact nodules containing adult worms of Onchocerca volvulus were homogenized in the presence of protease inhibitors and fractionated into particulate and aqueous isotonic soluble antigens. Systematic analysis of these Ag fractions showed considerable amounts of Ig, presumably associated with Ag in the form of immune complexes. Individual specific antibody reactions from all 778 patients to nodule Ag were examined. Reactions to O. volvulus antigens by antibodies from patients with confirmed parasitic infections were almost exclusively restricted to IgG1 and IgG4 isotypes. Antigenic activity appeared to be primarily associated with low molecular mass (14 to 29 kDa) components. Some competitive blocking of antibody activities of other isotypes by IgG1 was observed, most notable was that of IgG3 and IgA. IgG4 and IgM activities were not significantly blocked.
Adolescent↗
Are "medically underserved areas" medically underserved?
A comparison of medically underserved areas (MUAs) and adequately served areas (ASAs) is presented. Nonmetropolitan areas represented in the Health Interview Survey (HIS) are classified as MUAs or ASAs by the official criterion of their scores on the Index of Medical Underservice (IMU), and HIS data from the two types of areas are examined for differences. Standard metropolitan statistical areas are also compared with the nonmetropolitan MUAs and ASAs. Results show no difference between MUA and ASA residents in number of physician visits per year or proportion with at least one visit in the past year, although MUA residents reported poorer health status, used some preventive services less, and used nonsurgical hospitalization more than did ASA residents. In gereral, most MUA-ASA differences tend to be similar in size to differences between ASAs and SMSAs. An alternative to the IMU, using HIS data to identify underserved areas, is discussed.
Adolescent↗
Determinants of adolescent physical activity and inactivity patterns.
OBJECTIVES: Despite recognition of the important influence of environmental determinants on physical activity patterns, minimal empirical research has been done to assess the impact of environmental/contextual determinants of physical activity. This article aims to investigate environmental and sociodemographic determinants of physical activity and inactivity patterns among subpopulations of US adolescents. We define environmental determinants as modifiable factors in the physical environment that impose a direct influence on the opportunity to engage in physical activity. The present research examines environmental and sociodemographic determinants of physical activity and inactivity with the implication that these findings can point toward societal-level intervention strategies for increasing physical activity and decreasing inactivity among adolescents. STUDY DESIGN AND METHODOLOGY: The study population consists of nationally representative data from the 1996 National Longitudinal Study of Adolescent Health on 17 766 US adolescents enrolled in US middle and high schools (including 3933 non-Hispanic blacks, 3148 Hispanics, and 1337 Asians). Hours/week of inactivity (TV/video viewing and video/computer games) and times/week of moderate to vigorous physical activity were collected by questionnaire. Outcome variables were moderate to vigorous physical activity and inactivity, which were broken into categories (physical activity: 0-2 times/week, 3-4 times/week, and >/=5 times/week; inactivity: 0-10 hours/week, 11-24 hours/week, and >/=25 hours/week). Sociodemographic and environmental correlates of physical activity and inactivity were used as exposure and control variables and included sex, age, urban residence, participation in school physical education program, use of community recreation center, total reported incidents of serious crime in neighborhood, socioeconomic status, ethnicity, generation of residence in the United States, presence of mother/father in household, pregnancy status, work status, in-school status, region, and month of interview. Logistic regression models of high versus low and medium physical activity and inactivity were used to investigate sex and ethnic interactions in relation to environmental and sociodemographic factors to examine evidence for the potential impact of physical education and recreation programs and sociodemographic factors on physical activity and inactivity patterns. RESULTS: Moderate to vigorous physical activity was lower and inactivity higher for non-Hispanic black and Hispanic adolescents. Participation in school physical education programs was considerably low for these adolescents and decreased with age. Participation in daily school physical education (PE) program classes (adjusted odds ratio [AOR]: 2.21; confidence interval [CI]: 1.82-2.68) and use of a community recreation center (AOR: 1.75; CI: 1.56-1.96) were associated with an increased likelihood of engaging in high level moderate to vigorous physical activity. Maternal education was inversely associated with high inactivity patterns; for example, having a mother with a graduate or professional degree was associated with an AOR of.61 (CI:.48-.76) for high inactivity. High family income was associated with increased moderate to vigorous physical activity (AOR: 1.43; CI: 1.22-1.67) and decreased inactivity (AOR:.70; CI:.59-.82). High neighborhood serious crime level was associated with a decreased likelihood of falling in the highest category of moderate to vigorous physical activity (AOR:.77; CI:.66-.91). CONCLUSIONS: These results show important associations between modifiable environmental factors, such as participation in school PE and community recreation programs, with activity patterns of adolescents. Despite the marked and significant impact of participation in school PE programs on physical activity patterns of US adolescents, few adolescents participated in such school PE programs; only 21.3% of all adolescents
Adolescent↗
Residency training in dental public health: assessment of status, needs, and issues.
The opportunities for public health training have declined over the years while the need for public health skills is likely to increase. This paper reports the results of a project, sponsored by the Health Resources and Services Administration, which answers the question of "how best to invest in the dental public health education system so as to fulfill the profession's responsibilities to protect and improve the oral health of individuals and society." An information base on dental public health education, practice, and specialization was developed from an extensive review of the literature and a survey of dentists concerning employment and practice requirements for public health dentists. An advisory group considered this information, met to discuss the issues involved in dental public health training, and provided advice to the project staff. Based on the information gathered as part of the project, recommendations were made to: (1) develop a grant program to support advanced education in dental public health; (2) increase the competencies of dentists who are working in public health positions and not eligible for board certification via off-site residencies; (3) develop model programs in areas of great need, such as general public health, management, policy, prevention, environmental health and research, that in conjunction with a basic public health core, could satisfy the eligibility requirements of the American Board of Dental Public Health; (4) develop student loan forgiveness programs for dentists and dental hygienists working in public health; and (5) develop additional credential recognition programs for dental public health workers.
Certification↗
Health insurance coverage in U.S. urban and rural areas.
This study examines the health insurance coverage of the nonelderly population in U.S. urban and rural areas in 1989, using data from the March 1990 Current Population Survey conducted by the Bureau of the Census. Access to coverage was assessed by classifying all persons by family employment status and income. Rural residents had less access to coverage than urban residents but were only slightly less likely to be insured. In comparison to urban residents, fewer rural residents obtained coverage through employment, and more purchased private coverage outside the work place. The differences in coverage by family employment status and income were generally much greater than the differences by place of residence.
Adult↗
Estimates of population smoking prevalence: self-vs proxy reports of smoking status.
OBJECTIVES: In the face of rising costs of surveillance systems, it is time to reexamine the feasibility of including proxy respondents in surveys designed to provide population estimates of smoking prevalence. METHODS: Data are from the California. Tobacco Surveys, which are random-digit dialed telephone surveys. One adult provided demographic information and smoking status for all household residents. Additionally, some adults were selected for in-depth interviews that also included smoking status questions. We matched information from proxy respondents and self-respondents and evaluated smoking status discrepancies between them relative to demographic and other factors (n = 2930 matched pairs) in 1992. We address the potential bias these discrepancies might introduce into the population estimate of smoking prevalence. RESULTS: Overall, the discrepancy between proxy report and self-report was 4.3%, and it increased particularly when the self-respondent reported nondaily smoking or recent quitting. Discrepancies acted in both directions, and the net bias was that the screener survey overestimated smoking prevalence by 0.1% in 1992 (0.3% in 1990). CONCLUSIONS: Smoking status questions can be added to ongoing surveys such as the census or labor force surveys; one adult could provide smoking status for all household members.
Adult↗
Pain and cognitive status in the institutionalized elderly: perceptions & interventions.
The purposes of this study were to examine the relationship between: (1) nurses' ratings of pain and corresponding administration of pain medication to elderly long-term care residents, and (2) cognitive status of the elderly and pain medication orders/administration. Participants were 83 residents, 60 years of age and older, in two groups: cognitively impaired (n = 64), and cognitively intact (n = 19). For comparison purposes, 19 of the cognitively impaired subjects were matched on age and diagnosis to provide control for potentially painful conditions. A retrospective medication review of the resident's charts was conducted to compare medication orders and administration on analgesics that were scheduled and p.r.n. (given as needed). The pain ratings of 25 RNs using a visual analogue scale were correlated with pain medications given to the resident on the day of the rating. Results indicated that RNs' ratings of resident pain and the administration of pain medications were not significantly correlated. In addition, cognitively impaired residents were prescribed significantly less scheduled medication and received significantly less pain medication (either p.r.n. or scheduled) than the cognitively intact elderly. Implications for practice and research are discussed.
Aged↗