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Regional variation of nonrural pediatric ambulance transport rates: an ecological study.

STUDY OBJECTIVE: To determine the relationship of pediatric transport rates per hundred thousand pediatric population (RATE) to socioeconomic status (SES) factors and also mortality in Emergency Medical Services (EMS) systems. DESIGN: Retrospective ecological study. SETTING: Four EMS Medical Control Authorities (MCAs) in Michigan. PARTICIPANTS: Patients (3,792), 0-19 years of age, responded to as a nonscheduled emergency response and transported to a hospital by ambulance. METHODS AND MEASUREMENTS: RATE, economic status (INCOME), private transportation status (VEHICLE), educational status (EDUC), primary care physician availability (PHYS), and EMS disease death rate (EMSDD) were determined for each MCA and analyzed using Spearman rank correlation. RESULTS: RATE between MCAs varied from 325 to 750. RATE was highest in the most urban MCA: its 0-4 RATE was fourfold larger than any other MCA. INCOME, EDUC, and VEHICLE were inversely correlated with transport rate: -1.00, -1.00, -1.00; P < 0.001. Rate was positively correlated with EMSDD: 1.00; P < 0.001. CONCLUSIONS: Substantial variation in RATE between MCAs may be primarily due to the high 0-4 transport rate in the most urban MCA. This study also suggests that higher pediatric EMS system utilization rates may be correlated to higher mortality and also to unavailability of personal transportation.

Adolescent↗

Fall-related brain injuries and the risk of dementia in elderly people: a population-based study.

Severe head injury in early adulthood may increase the risk of dementia in older age, but it is not known whether head injury in later life also increases the risk of dementia. A representative sample (82%) of persons aged 70 years or older with a Mini-Mental State Examination (MMSE) test score of > or =26 (n = 325) were followed-up for 9 years to record all their fall-related head injuries resulting in traumatic brain injury (TBI). At the end of the follow-up period, 152 persons (81% of the surviving population) were examined for clinical dementia, according to DSM-IV criteria. Eight persons sustained a TBI and 34 developed dementia. Brain injury was associated with younger age at detection of dementia even when adjusted for sex and educational status (low educational status significantly associated with dementia); age-specific hazard ratio (95% confidence interval) 2.80 (1.35-5.81). In a population scoring > or =28 points in the baseline MMSE an apolipoprotein E (ApoE) epsilon4 phenotype was also associated with younger age at the time of detecting dementia; 3.56 (1.35-9.34), and the effect of brain injury and ApoE epsilon4 phenotype was synergistic; 7.68 (2.32-25.3). We conclude that fall-related TBI predicts earlier onset of dementia and the effect is especially high amongst subjects who carry the ApoE epsilon4 allele.

Accidental Falls↗

The influence of recovery status and education on addiction counselors' approach to treatment.

The goal of this study is to examine the influence of education and recovery status on substance abuse treatment counselors' approach to patients. Three hundred forty-four drug abuse and alcoholism treatment counselors were questioned about treatment goals. A subgroup of 197 were also questioned about treatment practices. The influences of education and recovery status on the choice of treatment goals and treatment practices were examined through structural modeling procedures. Level of education influenced neither treatment goals nor techniques. Being in recovery, however, was associated with more varied treatment techniques and a broader range of treatment goals. The other variable related to treatment goals and practices was treatment modality. Working in residential programs was linked to a wider range of treatment goals and treatment practices. Implications of these findings for counselor training and the movement to professionalize substance abuse treatment are discussed.

Counseling↗

Prevalence of Helicobacter pylori infection in asymptomatic subjects in Libya.

Helicobacter pylori infection is very common infection worldwide particularly in the developing countries. No detailed study on such infection is being recorded so far in Libya. The aims of the study were to detect H. pylori prevalence in asymptomatic Libyan subjects, to determine the rate of infection among different age groups and to correlate the prevalence of H. pylori with age, sex, smoking, non-steroidal anti-inflammatory drugs intake, marital status, education, and socioeconomic status. Three hundred and sixty asymptomatic subjects 1->70 years of age (average 36) with no previous history of epigastric pain were selected randomly from the Libyan population. Serum samples were obtained and a questionnaire was filled for each subject. The ELISA test was used to detect IgG anti-H. pylori antibodies. An overall prevalence of 76% was detected in these subjects. A 50% infection rate were in subjects 1-9 years of age that increased to 84% in subjects 10-19 years and continued with increasing age and reached up to 94% in those over 70 years of age. Subjects > 45 years of age had significantly higher antibody response than those <45 years. H. pylori prevalence was higher in married subjects (84%) as compared to singles (68%) and similarly in illiterates (89%) and low socioeconomic subjects (91%). No difference in sex, smoking and NSAIDs intake was recorded. Infection with H. pylori is highly prevalent in the Libyan asymptomatic subjects. Infection acquired early in childhood and reached up to 94% in older age. Prevalence of H. pylori was significantly increased in association with marital status, education and low socioeconomic status.

Adolescent↗

Predictors of older adults' longitudinal dental care use. Ten-year results.

Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985. The 540 persons who participated in all four waves are the subject of this report. The remainder either died, entered nursing home, or were lost to follow-up. This longitudinal design permits analysis of cohort, aging, and period effects. The outcome variables were self-reported dental care use within two years, or more than two years, as reported at waves 1, 3, and 4. Wave 2 was excluded because less than two years had elapsed since the previous wave. To identify factors predictive of reported use, we used a generalization of the logistic regression model that included a random effect term, which accounts for repeated measures being made on the same subjects. Covariates in the model were dentate status, education, income, cohort, sex, martial status, and time. The variable "time" served as a measure of aging/period effects. Persons were grouped into four birth cohorts. Before adjusting for other covariates, cohort was significantly associated with dental care use, but was not so in the full multivariate model. Dentate status, education, and income were significant predictors of use. The cohort effect was explained by dentate status, education, and income. Time was not significant, indicating no aging/period effects in this ten-year period, or that their net effect was zero.

Aged↗

Relationship of socioeconomic status with cardiovascular risk factors and lifestyle in a Mediterranean population.

BACKGROUND: Socioeconomic status greatly affects cardiovascular risk factors and lifestyle. Aim of the study To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. AIM OF THE STUDY: To analyse the relationship between socioeconomic status and both cardiovascular risk factors and behavioural variables. METHODS: The present random sample of 838 men and 910 women of the 25 to 74 year old general population of Gerona according to the 1991 census, included cardiovascular risk factor measurements (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glycaemia, systolic blood pressure, diastolic blood pressure, body mass index, waist to hip ratio, and waist circumferences) and evaluation of dietary habits, alcohol consumption, smoking, and leisure-time physical activity with corresponding questionnaires. RESULTS: In this study, we used lifestyle factors (leisure-time physical activity, tobacco consumption, and alcohol drinking habits) in addition to dietary habits to determine whether changes in these factors correlate with the socioeconomic status, classified as degree of educational level, in a representative Spanish Mediterranean population. Multiple linear regression analysis adjusted for several confounders revealed a direct association of LDL-cholesterol (p = 0.03) and body mass index (p = 0.02) with low levels of educational status in men and women, respectively. A higher educational status was directly (p = 0.04) related to the smoking status in women. The two composite dietary scores, indicating overall dietary quality and cardiovascular protecting properties, were not associated with low socioeconomic status in our population. CONCLUSION: Dietary habits, alcohol drinking, and leisure-time physical activity seems not to be affected by educational status in either gender. This finding might partially explain the relationship between cardiovascular risk factors and socioeconomic status in our population. The importance of cultural values in the rural area of the Spanish province seems to be the stronger factor compared with education.

Adult↗

Demographic and socioeconomic predictors of dental care utilization.

The authors analyzed a comprehensive, nationally representative data set from the 1989 National Health Interview Survey to determine what factors are related to dental care utilization. The authors estimated the percentage of low-income and minority adults who reported visiting a dentist in the past year by race, income, employment status, dental insurance coverage status, sex, health status, education, marital status, age and major activity. Data analyses focused on 49,687 18- to 64-year-old dentate respondents, who were black, Hispanic or white. The authors found large differences in dental care utilization between blacks, Hispanics and whites, when controlling for education, income, age and other variables.

Adolescent↗

Lactose malabsorption in preschool black children.

One hundred sixteen healthy black children ages 13 to 59 months, representing high and low socioeconomic deciles, were studied for lactose malabsorption. A fasting lactose tolerance test using 2 g of lactose/kg of body weight was carried out. Glucose was determined at 0, 15, 30, and 60 min. Of the 116 preschoolers 34 (29%) evidenced lactose malabsorption as determined by a blood glucose rise of less than 26 mg/100 ml. Clinical signs of diarrhea, gas, and cramps were noted singly or in combination in 18% of the 34 lactose-malabsorbing children. Of the 82 lactose absorbers, 12% demonstrated similar signs. The nature and length of the initial infant milk feeding failed to show any relationship to the onset of malabsorption. Current milk drinking patterns were reported as being similar. Eight-seven percent of the malabsorbers and 92% of the absorbers report drinking 240 ml or more of milk/day. Socioeconomic status, education, marital status, and medical assistance of the parent is similarly distributed between lactose absorbers and malabsorbers.

Absorption↗

Adolescents' media use: a European view.

European adolescents' use of mass media differs significantly by gender, family life, social economic status, and education, according to recent studies. For example, boys are more likely than girls to have a television in their own room, and content preferences are dramatically different. Recent studies also suggest that family dynamics may change as new media technologies are introduced. In some studies, the mother's educational status has been more directly related to patterns of electronic media use than the father's, and adolescents' commitment to school has been shown to predict music preferences. To make meaningful generalizations about adolescents and the media in the future, these and other mediating factors, including ethnicity and cognitive development, must be considered.

Adolescent↗

Relationship of bone and blood lead levels to psychiatric symptoms: the normative aging study.

Blood and bone lead levels were used to investigate lead's potential effect on psychiatric symptoms among middle-aged to elderly men from the Normative Aging Study. Symptoms were assessed using the Brief Symptom Inventory (BSI) and analyzed as individual outcomes as well as a measure that combined anxiety, depression, and phobic anxiety. Blood and bone lead averaged 6.3 microg/dL (standard deviation [SD] = 4.16), 21.9 microg/g (SD = 13.5), and 32.1 microg/g (SD = 19.8) for blood, tibia, and patella lead, respectively. In logistic regression models that adjusted for age, alcohol intake, employment status, and education status, we found that patella bone lead was significantly associated with an increased risk of phobic anxiety and the combined outcome measure at the P </= 0.05 level. Tibia and blood lead had similar associations. We conclude that cumulative lead exposure, which bone lead levels reflect, could be a risk factor for psychiatric symptoms even at modest levels of exposure.

Adult↗

Sources of variability in quantitative levels of alcohol use in a total community: sociodemographic and psychosocial correlates.

This article describes the transformation of reported alcohol consumption into a quantitative variable, Standardized Alcohol Intake (SAI), which is used to investigate various sociodemographic and psychosocial factors as correlates of alcohol use in a total community sample (N = 1672), in Tecumseh, Michigan. Statistically significant relations were obtained between alcohol usage and marital status, education, smoking status, and church attendance with the latter accounting for the 15% of the variability in drinking. On measures of personality, SAI was positively and significantly associated with level of activity, sociability, impulsivity, and extraversion. For drinkers, their attitudes toward drinking and changes in mood varied significantly in relation to the amount consumed. These findings are important and necessary for the appropriate control of these correlates in the future study of familial aggregation of SAI in the Tecumseh community.

Adult↗

Functional transitions in instrumental activities of daily living among older Japanese.

We observed functional transitions in instrumental activities of daily living (IADL) over one year among older Japanese and examined factors influencing the deterioration of each IADL. The sources of the study were the first and second panel studies of the Saku Longitudinal Study on Aging, which were done in 1988 and 1989. The study subjects were those participants aged 70 or older. Five IADL items--using public transportation, shopping for daily necessities, preparing meals, paying bills, and managing deposits--were measured in each survey. Deterioration of each IADL item was examined in relation to demographic characteristics such as age, sex, occupational status, living arrangements, and educational status. Of the effective baseline cohort (n = 5,559), 4,892 responded in the second survey (response rate 88%). Over 80% of the respondents who were initially independent in each IADL item remained independent in the second survey. Multiple logistic regression analyses revealed that greater age, having no occupation, and living with children at the baseline were associated with deterioration in each item of IADL. Lower educational status was associated with deterioration in each item of IADL except preparing meals. This study indicates that being engaged in work, living separately from children, and having higher educational status are strongly correlated with remaining independent in IADL for older people aged 70 or older.

Activities of Daily Living↗

Relationships among education, dentate status, and diet in adults.

The Nutrition and Oral Health Study (NOHS) was established to study the interrelationship of oral health status, dietary intake, and education, and to define their relative impact on the middle aged and elderly. Two hundred forty-seven partially or fully dentate (at least 6 teeth) subjects returned two food diaries over a 16-month period. Despite the investigators' efforts to enroll from a socio-economically diverse Boston population, the volunteers were health-conscious, with 85% having been to the dentist within the last year; 95% brushed, and 60% flossed daily. More than half the volunteers had attended college. With the exception of cholesterol intake, which was high in both the higher- and lower-educated males, most individuals, despite their dentate status, sought good nutrition. People who wore dentures consumed more refined carbohydrates and sucrose. As the number of teeth declined, Vitamin A, crude fiber, and calcium declined, while cholesterol rose. These factors may have a significant implication for general health.

Adult↗

Effects of economic status and education level on the height and weight of community adolescents in Nepal.

There is scarce information on the relative importance of socio-economic factors in determining the adolescent anthropometric measurements. The objective of this study was to examine the effects of economic status, education level, and food consumption on the height and weight of community adolescents in Nepal. The study was done in the communities of the Kathmandu Valley area in Nepal. All together 426 unmarried adolescent girls aged 14-19 y were selected. The adolescents were interviewed regarding socioeconomic background (education, occupation and property possessions) and frequency of foods consumption. Height and weight were determined and BMI was calculated. Z-scores of height-for-age and weight-for-age were calculated based on the WHO/NCHS standard to avoid bias by age. The adolescents participating in the survey were categorized into three groups using the various indicators of economic status: Low Economic Status (LES) group, Middle Economic Status (MES) group and High Economic Status (HES) group. The Z-scores of height and weight were significantly lower in the LES group than in the MES and HES groups (p<0.05). The Z-score of height was significantly increased with education level even under the condition of controlling economic level (p<0.05). Since the frequency of milk consumption was significantly related not only with height (p<0.05), but also with economic (chi2=31.6, df=4, p<0.001) and education levels (chi2=22.4, df=6, p<0.01), the increased height in the groups of the better economic status or the better education level was interpreted to be due to the outcome of the higher frequency of milk consumption. This study indicated that education was a more important factor affecting the height of the adolescents via improved food habits even under adverse economic conditions.

Adolescent↗