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PubMed2004

[Health of the unemployed in France: literature review].

BACKGROUND: This paper reviews and analyses the main publications concerning health and mortality of the unemployed in France, in order to formulate research orientations for future studies or secondary data analysis. METHODS: The conceptual framework was first set up by assembling the different hypotheses concerning the link between health and unemployment (causality versus selection). A review of the different studies was organized by type: health studies based on data from either cross-sectional health surveys at a national or regional scale, or longitudinal surveys, and mortality studies based on data from follow-up of census samples. RESULTS: Those studies confirm the health disadvantage of the unemployed relative to the employed, in terms of self-perceived health, morbidity, health services utilization and mortality. They provide arguments in favor of both the causality and selection hypotheses. CONCLUSION: The exact nature of the health conditions and causes of death associated with unemployment needs further clarification, as well as the causal pathways.

France↗

PubMed1998

Do groups of women aged 50 to 75 match the national average mammography rate?

CONTEXT: As mammography rates increase, an important question is how closely groups of women match or do not match the national-level, average screening percentage. OBJECTIVE: This study employed a classification-tree methodology to combine individual risk factors from multiple logistic regression, in order to more comprehensively define groups of women less (or more) likely to be screened. DESIGN/SETTING: This report was a secondary data analysis drawing on data from the 1992 National Health Interview Survey, Cancer Control Supplement (NHIS-CCS). PARTICIPANTS: Analyses examined mammography status of women aged 50-75 (n = 1,727). MAIN OUTCOME MEASURE: The dependent variable was having a screening mammogram in the past 2 years. Multiple logistic regression (SUDAAN) was conducted first to select significant correlates of screening. A classification-tree analysis (CHAID subroutine of SPSS) was then used to combine the significant correlates into exclusive and exhaustive subgroups. RESULTS: A total of 13 subgroups were identified, of which only six approximated the overall population screening rate. The lowest screening occurred in small clusters of women, which, when added together, formed a larger percentage of the population who were not screened within the past 2 years. CONCLUSIONS: Efforts to increase mammography may face the challenge of identifying relatively small pockets of women and addressing their individual barriers. Further work should be done to find efficient ways to combine individual risk factors into groups at risk for not being screened.

Aged↗

PubMed2002

Association of adolescent risk behaviors with mental health symptoms in high school students.

PURPOSE: To examine the hypothesis that self-reported symptoms of depression and stress may be associated with other risk behaviors. METHODS: A secondary data analysis of the 1992 Massachusetts Adolescent Health Survey involving a representative sample of 2,224 ninth and twelfth grade students was performed. The dichotomous dependent variable was positive if the adolescent reported feeling depressed or stressed for 10 or more days in the past month. Potential independent variables examined were age, gender, race/ethnicity, and 14 risk or protective behaviors: each scored on a seven point scale representing increasing frequency of a behavior in the past month. A four-level sexual risk variable was constructed as well. Associations were assessed using Chi-square, and phi/contingency coefficients, and logistic regression analyses to predict the odds of reporting depression/stress. RESULTS: The mean age of the sample was 16.2 +/- 1.6 years; 52% males; 78% were white, 9% black, 6% Latino, 2% Asian, and 4% other racial/ethnic heritage; 35% reported feeling depressed/stressed > or = 10 days in the past month. A logistic regression model found that feelings of depression/stress were associated with increasing age (OR = 1.09 with each additional year [95% CI, 1.02-1.18]), female gender (3.28 [2.62-4.12]); increasing levels of tobacco use (1.07 [1.01-1.12]), physical fights (1.19 [1.11-1.28]); and non-use of birth control compared with never having been sexually active (1.81 [1.31-2.49]). Independent variables of reporting depression/stress for males included increasing age (1.15 [1.03-1.28]), and physical fights (1.20 [1.10-1.30]), and non-use of birth control compared with never sexually active (1.91 [1.28-2.92]). Independent risk and protective factors for females included tobacco use (1.10 [1.02-1.19]), healthy diet (0.89 [0.83- 0.96]), and always (1.49 [1.03-2.28]) or sometimes used birth control (1.56 [1.03-1.28]) compared with never sexually active. CONCLUSIONS: Female gender had greater than threefold increased odds of reporting depression/stress. Other associations, with some gender differences, include older age, physical fights, non-use of birth control, lack of a healthy diet, and use of tobacco.

Adolescent↗

PubMed1999

Usual sources, patterns of utilization, and foregone health care among Hispanic adolescents.

PURPOSE: To describe and differentiate the usual sources of health care, patterns of utilization of services, and reasons for foregone health care among Hispanic adolescents by place of birth (U.S. mainland versus Puerto Rico or other country) and gender. METHODS: All subjects who identified themselves as Hispanic (n = 717) in a larger survey of 10,059 students in 7th (n = 3,596), 9th (n = 3,691), and llth (n = 2,772) grades in the state of Connecticut in 1996 were included in this secondary analysis. Data were analyzed using Pearson product-moment coefficients, Chi-squares, and logistic regression. RESULTS: The majority of usual sources of medical care services were community clinics or private doctors' offices. Subjects born in Puerto Rico or countries other than the United States were more likely to use a doctor's office. About 5% reported no usual source of care. Over 25% reported not going to a doctor or other health care provider when they thought they should (foregone care). There were significant gender differences in reasons given for foregone care. Feeling connected to others was a significant predictor of having had a physical examination and negatively associated with foregone care for girls. For boys, connectedness and use of alcohol were negative predictors of foregone care. CONCLUSIONS: The majority of Hispanic youth in this sample report having a usual source of medical care and the source differs by place of birth. Adolescents who do not report high levels of connectedness are more likely to have foregone care. The most frequent explanation given for not having sought care was that subjects thought the problem would go away. Socialization about how to access and use health care services, as well as what to expect, is needed by Hispanic adolescents who may be at risk.

Adolescent↗

PubMed1998

Failure to immunize the elderly: a systems problem or a statement of personal values?

BACKGROUND: Despite the proven efficacy of the influenza vaccine in reducing the risk for pneumonia, hospitalization, and death and the potential savings in costs, most elderly persons do not receive annual immunizations. The study tested the influence of health care delivery system characteristics and individual personal values on the influenza immunization status. METHODS: The study involved a secondary data analysis based on the results of a mailed survey of 3,362 seniors 65 years of age and older enrolled in HealthPartners, a mixed-model health maintenance organization in Minnesota. The three care delivery systems in which respondents were enrolled varied in the intensity and consistency with which they addressed immunization. RESULTS: The immunization rate for this population (77.1%) was higher than the state rate (64%). After controlling for many variables historically known to influence the likelihood of immunization, both care delivery system characteristics and personal values remained significantly associated with immunization status. Elderly individuals getting care in delivery systems with well-developed immunization programs were more likely to be immunized. Those who avoided going to the physician and who practiced risky behaviors such as smoking were less likely to be immunized, regardless of the care delivery system they were enrolled in. DISCUSSION: Managed care can provide a number of system improvements to assist in meeting national health care objectives such as influenza immunization for the elderly. It has reduced some common barriers to immunization, such as cost and access. Yet to achieve the full benefits of a successful influenza immunization program, the role of individual values, as well as implementing systems solutions, needs to be addressed.

Aged↗

PubMed2005

Undermining self-efficacy: the consequence of nurse unfriendliness on client wellbeing.

Although unfriendly nurse behaviours are noted in research findings, no study names these behaviours as such, nor investigates the impact of nurse unfriendliness on clients. Because the present findings reveal the phenomenon of nurse unfriendliness, they allow both the phenomenon and its consequences to be understood. These findings were developed through secondary data analysis of a text where participants discussed their encounters, during hospitalisation/s in 2002-2003, with friendly and unfriendly nurses. Findings reveal nurse unfriendliness is characterised by frostiness, officiousness and apathy. It results in thoughtless and inept nursing and in a hostile environment where clients feel unsafe, unwelcome and unaided. Unfriendly nurses create barriers--they are disrespectful, cheerless, unresponsive and domineering so clients feel belittled, disheartened, unprotected and distressed. When clients are placed in this position, their self-efficacy is undermined. By revealing the consequences of nurse unfriendliness on client wellbeing, findings from this study advance nursing knowledge.

Adult↗

PubMed2006

The association between congestive heart failure and cognitive performance in a primary care population of elderly adults: the Steel Valley Seniors Survey.

BACKGROUND: Evidence suggests an association between congestive heart failure (CHF) and cognitive function, particularly in heart transplant patients and patients hospitalized for CHF. We examined the association between CHF and cognitive performance in stable outpatients recruited from primary care. METHODS: This is a cross-sectional secondary data analysis of the Steel Valley Seniors Survey, an epidemiological study of elderly primary care outpatients. Participants aged >/= 65 years were recruited in primary care clinics. The study cohort (n = 354) is a subgroup, composed of subjects with Mini-mental State Examination score < 25, and a random sample of the remaining, who underwent a baseline assessment in the home. The assessment included demographics, comorbid illnesses, depressive symptoms, functional status, a neurological examination and a neuropsychological battery. CHF is defined by self-report and/or chart review, and stable CHF as not being hospitalized in the year prior to the assessment. The associations between CHF and specific cognitive tests were examined by bivariate analysis and logistic regression, controlling for demographic variables. RESULTS: Subjects with CHF performed worse on tests of visual memory [10.1 (S.D. 5.4) vs. 12.7 (S.D. 5.2), p = 0.007], Trailmaking B [0.1 (0.1) vs. 0.2 (0.1), p = 0.002], category fluency [11.1 (4.4) vs. 13.4 (4.5), p = 0.008], and clock drawing [5.6 (1.9) vs. 6.7 (1.4), p < 0.001] compared to subjects without CHF, after adjustment for relevant demographic variables. CONCLUSION: CHF is associated with lower cognitive functioning in a population of patients with stable heart failure in primary care settings.

Aged↗

PubMed1998

Clinical Features of Emergency Department Patients Presenting with Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter Study.

Identification of patients with acute cardiac ischemia (ACI) remains challenging. The object of this study was to examine the role of clinical findings in the diagnosis/triage of emergency department (ED) patients with symptoms suggestive of ACI. The study was designed as a secondary data analysis of a multicenter prospective controlled clinical trial. It was set in 10 midwest, southeast, and northeast U.S. hospitals, and 10,689 patients with chest pain or other symptoms suggesting ACI presenting from May 1993 to December 1993, participated. The results indicated that ACI patients were more likely to have chest pain as a chief complaint or presenting symptom (P = 0.001). The presenting symptom of nausea was more commonly associated with a final diagnosis of ACI (P = 0.003). Shortness of breath as the chief complaint and presenting symptoms of abdominal pain, nausea, dizziness, and fainting were less frequent among patients with a final diagnosis of ACI (P = 0.001). A past history of diabetes mellitus, myocardial infarction, or angina pectoris was more frequently associated with a final diagnosis of ACI (P = 0.001). A lower pulse rate in patients with a final diagnosis of ACI (P = 0.001) was not considered clinically significant. Median first and highest systolic blood pressures (SBPs) were higher, median lowest SBPs were lower, median diastolic blood pressure of the lowest SBPs were lower, and initial and highest pulse pressures were wider in patients with a final diagnosis of ACl (P = 0.001). On arrival, these blood pressure variables in AMI patients, subsequently classified as Killip class 4, were above the threshold for this classification. Rales were more commonly present in patients with a final diagnosis of ACI (P = 0.001). All primary ST-segment abnormalities, Q waves, and T-wave abnormalities, except T-wave flattening, were seen more frequently in patients with a final diagnosis ACI (P = 0.001). Normal ECGs were more frequently associated with a non-ACI final diagnosis, yet 20% of AMI patients and 37% of Unstable Angina Pectoris (UAP) patients had normal ECGs. It can be concluded that certain clinical features can help to identify ED patients with ACI. Initially normal ECGs can be seen in 20% of patients with AMI and 37% of patients with UAP. Patients with ACI can present with "normal" blood pressures and develop cardiogenic shock. Clinical outcome data for ACI patients are presented.

Journal Article↗

PubMed2002

Using the standard error of measurement to identify important changes on the Asthma Quality of Life Questionnaire.

OBJECTIVES: To establish a link between the minimal important difference (MID) and the standard error of measurement (SEM) for all responsive dimensions of the Asthma Quality of Life Questionnaire (AQLQ). METHODS: Secondary data analysis of baseline and follow-up interview data from 198 outpatients with asthma enrolled in a randomized controlled trial and receiving care at a major urban academic medical center's general medicine clinics. Domain statistics for baseline and follow-up interviews were examined for the AQLQ. The baseline SEM values were compared with established AQLQ MID standards using weighted kappa values. RESULTS: One SEM identified the MID in responsive AQLQ dimensions. Weighted kappa values (0.88-0.93) validated excellent agreement between these two criteria. CONCLUSION: This is the third study to support using one SEM to identify important individual change in health-related quality of life (HRQoL) measures. However, refinement of the process for determining a measure's clinically meaningful differences is still needed to secure a link between the SEM and the identification of relevant HRQoL change over time.

Asthma↗

PubMed2002

The relationship between acculturation and problem behavior proneness in a Hispanic youth sample: a longitudinal mediation model.

This study, using secondary data analysis, examined prospectively a mediation model of the relationship between acculturation and problem behavior proneness among 330 Hispanic children and adolescents from an urban school district in the southwest region of the United States. Acculturation was predicted to have an indirect, but positive, relationship to problem behavior proneness through parental involvement and self-esteem. The results partially supported the model and indicated that parental involvement, but not self-esteem, played a significant mediational role in children's problem behavior proneness. The individual indicators of problem behavior proneness among Hispanic youth were significantly interrelated, which is consistent with problem behavior theory as conceptualized by R. Jessor (1984) and R. Jessor and S. L. Jessor (1977). Findings from this study provide implications for future research and intervention designs.

Acculturation↗

PubMed2004

Functional disability and associated factors among older Zuni Indians.

Few studies have focused on American Indian elderly and functional disability, and none have explored potential moderating or mediating factors that may lend themselves to subsequent intervention. The purpose of this study was to describe the extent of functional disability in elders and to determine which factors were associated with a higher number of Activities of Daily Living (ADL) limitations. The study was a secondary data analysis of an existing survey of American Indian elders in one southwest tribe. Functional disability was defined as limitations in ADLs and was measured by the percent of respondents reporting specific limitations and by the mean total ADL limitations. Multiple linear regression analyses were used to determine the demographic, socioeconomic and health factors associated with ADL limitations. In the 90 elders surveyed, 40 percent of respondents reported a limitation with bathing, 31 percent with walking, and 22 percent with dressing. Only 6 percent of the elders surveyed, however, reported their health status as "poor" on a 5-point scale. Factors associated with more ADL limitations included poorer health status, less frequent exercise, and more elder care services used. Rates of functional disability in this tribe were higher than those found in the U.S. for all races. Further studies are needed to understand functional disability in American Indian elders and their need for long-term care services.

Activities of Daily Living↗

PubMed2002

[Frequency of oral hygiene nursing in cancer patients in Belgian hospitals. Frequency of nursing interventions and indicators].

This article describes the frequency of mouth care for cancer patients in Belgian hospitals. It also analyses the indicators used for this specific type of compensatory nursing care. The study was designed as a secondary data analysis of the 1990 Belgian Nursing Minimum Data set. The randomised sample included 35,347 oncology patients. Frequency of mouth care was 10.3%. The most important indicators were ventilation (70.58%), nasogastric tube (55.01%), endotracheal tube (43.17%), isolation of the patient (40.57%), malignant neoplasmas of lip, cavity and pharynx (40.21%), age younger than 8 years (37.06%) and disorientation of the patient (31.49%). Frequency of mouth care increased with a higher qualification of staff and higher staffing ratios.

Adolescent↗

PubMed1998

A study of elderly suicides in Hong Kong.

Hong Kong has one of the highest rates of suicide among the elderly in the world. Most of the existing suicide prevention programs have had very little effect on the elderly, who rarely utilize these programs. This study aims to help in understanding the problem, so that effective prevention can be provided to this high-risk group of suicidal people. Specifically, the study (1) describes the characteristics of the suicidal elderly, (2) investigates the reason(s) why the elderly are in distress and become suicidal, and (3) formulates a policy and service model to reach the elderly high-risk group. This research project involves secondary data analysis. Police records on elderly suicide cases in 1992 were scrutinized to find out the major reason(s) for fatal death in the elderly. Our study points out those districts that are more crowded and have fewer medical and social facilities tended to have higher suicide rates. Most of the deaths occurred at home or nearby, and the suicidal elderly were alone before their death. The majority of elderly suicide victims suffered from chronic diseases. Very few of them, however, were totally dependent: About 40% of the cases had consulted medical practitioners, and 27% had consulted psychiatrists within one month before their deaths. Close to 70% of the cases had indicated to family members or other their suicidal thoughts, and many of them had revealed numerous suicidal indications. Both policy and practice issues are discussed in light of the findings.

Age Distribution↗

PubMed1999

Parental language and verbal responsiveness to children in crowded homes.

This article is a secondary data analysis of the University of Kansas Language Acquisition Project, which intensively studied, on a regular basis, parent and child language from age 6 months to 30 months. The association between residential density and parent-child speech was examined. Parents in crowded homes speak in less complex, sophisticated ways with their children compared with parents in uncrowded homes, and this association is mediated by parental responsiveness. Parents in more crowded homes are less verbally responsive to their children. This in turn accounts for their simpler, less sophisticated speech to their children. This mediational pathway is evident with statistical controls for socioeconomic status. This model may help explain prior findings showing a link between residential crowding and delayed cognitive development.

Child, Preschool↗

PubMed1991

Gender differences in affiliation and instrumentality across adulthood.

This secondary data analysis tests the hypothesis that gender differences decline across adulthood. Six measures tapping 3 dimensions of affiliation and instrumentality were selected from the cross-sectional sample surveys of The Quality of American Life (1971) and Americans View Their Mental Health (1976). In both studies, approximately 2,200 adults who had been selected from probability samples of households in the continental United States were interviewed. For each measure, the variance explained by age, sex, and Age x Sex interaction terms was compared with the variance explained by age and sex alone. The addition of the interaction terms does not significantly increase the R2 for any of the measures, arguing against a late-life convergence of men's and women's orientations. Although the release from active parenting has been proposed as a basis for declining gender differentiation, limiting the analyses to respondents with children does not change this conclusion.

Achievement↗

PubMed1998

Correlates of body weight in the 1994 National Population Health Survey.

OBJECTIVE: This study examines three specific questions about obesity and overweight, using a nationally representative sample of Canadians. Are sociodemographic and lifestyle behaviors associated with body weight? Is body weight correlated with specific health outcomes? Has the prevalence of obesity in Canada changed since 1978? METHODS: Secondary data analysis of a cross-sectional survey. SAMPLE: This study uses the 1994 National Population Health Survey (NPHS) by Statistics Canada. It is a stratified random sample of 19600 Canadians across all provinces. RESULTS: The results show that age, gender, education, birth place and region, are significantly associated with obesity. When a lower criterion is used for overweight and obesity (body mass index, BMI > or = 25), dummy variables for marital status and occupation are also significant. Second, obesity is associated with poorer self-rated health, high blood pressure, heart disease, diabetes, arthritis, respiratory and stomach problems. For those respondents who have a BMI score of 25 or greater, there is also an association with stroke. Finally, it is unclear whether the prevalence of obesity has changed. However, there appears to be a systematic difference between studies using actual height and weight measurements (anthropometric) vs self-reported measurements. CONCLUSIONS: Weight can be considered a modifiable risk factor and reductions in the prevalence of obesity should reduce the risk of specific chronic conditions. Provincial variations in the prevalence of obesity (BMI > or = 27) and overweight and obesity (BMI > or = 25) suggest that collapsing provinces into regions may obscure important inter-provincial differences in body weight. More research is required to assess whether or not obesity is decreasing in Canada. Some of the limitations of self-reported data are discussed.

Adult↗

PubMed2001

Relationship of leisure-time physical activity and occupational activity to the prevalence of obesity.

OBJECTIVE: To assess the interaction between leisure-time physical activity (LTPA) and occupational activity (OA) on the prevalence of obesity. DESIGN: Secondary data analysis of a population based cross-sectional US national sample (NHANES III). SUBJECTS: A total of 4889 disease-free, currently employed adults over age 20 y. MEASUREMENTS: Subjects body mass index (BMI) was categorized as (1) obese (BMI> or =30 kg/m(2)), or (2) non-obese (BMI<30 kg/m(2)). LTPA was divided into four categories: (1) no LTPA; (2) irregular LTPA; (3) regular moderate intensity LTPA; and (4) regular vigorous intensity LTPA. OA was grouped as (1) high OA and (2) low OA. Age, gender, race-ethnicity, smoking status, urbanization classification, alcohol consumption and income were statistically controlled. RESULTS: In all, 16.8% (s.e. 0.7) of the total subject population were obese (15.1% (s.e. 1.1) of men and 19.1% (s.e. 1.1) of women). Logistic regression revealed that compared to those who engage in no LTPA and have low levels of OA, the likelihood of being obese is 42% (95% CI 0.35, 0.96) lower for those who engage in no LTPA and have high OA, 48% (95% CI 0.32, 0.83) lower for those who have irregular LTPA and have high levels of OA, and about 50% lower for all those who have regular LTPA through moderate or vigorous activity levels regardless of OA level. CONCLUSION: When considering disease free adults above 20 y of age employed in high and low activity occupations, a high level of occupational activity is associated with a decreased likelihood of being obese.

Adult↗

PubMed2005

Low birth weight and preterm births: etiologic fraction attributable to prenatal drug exposure.

OBJECTIVES: To determine the factors that would increase the likelihood of outcomes: low birth weight (LBW), preterm births and intrauterine growth restriction (IUGR). STUDY DESIGN: Secondary data analysis from a multi-center study. Risk factors for each outcome were derived from logistic regression models. Odds ratios (OR), 95% confidence intervals, and population-attributable risk proportions (PAR%) were estimated. RESULTS: Prenatal cocaine exposure increased the likelihood of LBW (OR: 3.59), prematurity (OR: 1.25), and IUGR (OR: 2.24). Tobacco, but not marijuana, significantly influenced these outcomes. Alcohol had an effect on LBW and IUGR. Etiologic fractions (PAR%) attributable to tobacco for LBW, prematurity, and IUGR were 5.57, 3.66, and 13.79%, respectively. With additional drug exposure including cocaine, estimated summary PAR% increased to 7.20% (LBW), 5.68% (prematurity), and 17.96% (IUGR). CONCLUSION: Disease burden for each outcome increases with each added drug exposure; however, etiologic fraction attributable to tobacco is greater than for cocaine.

Cocaine↗