Massachusetts Department of Public Health. Determining the needs of the elderly and the chronically disabled.
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Activities of Daily Living↗
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Results for “Health--determinants”
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[Psychiatric diseases in the elderly in an urban Aragonese population (Spain) and their relation to health determinants].
As a part of the SAMAR 89 Project on mental health, we present the results of a psychiatric epidemiological research (in two stages) in a representative sample of the elderly urban population of Zaragoza (Spain). We study the relation between psychological disorders and sociodemographic factors, and network and social support. In the first stage we use a adaptation of the Enquête Santé Quebec and the General Health Questionnaire of 28 items of Goldberg. The Clinical Interview Schedule and the monumental state of Folstein were used for the psychiatric diagnoses in the second stage (diagnoses criteria of the DSM-III). The psychological disorders were more frequent on the women, the more aged and the ones of low socioeconomic level. Also was detected a correspondence between bad mental health and problems in the network and social support.
Age Factors↗
Levels of health development: a new tool for comparative research and policy formulation.
Levels of health development are formed by mathematically clustering countries using six health status indicators: crude birth, crude death, infant mortality and child death rates, and male and female life expectancy. Stratifying two international samples of 128 and 163 countries into levels of health development--groups with similar health status profiles--improves the results of regression analyses used to identify economic, political, social, educational, health and other health determinants. For this reason, health development levels are a systematic framework for delineation of health determinants. Earlier large scale statistical studies have been limited in their success in part because they did not partition their data sets prior to analysis, or used inappropriate criteria that blurred rather than heightened developmental differences in underlying social systems. These developmental differences regulate the way in which health status inputs are converted into health status outputs, defining the relative importance of health determinants at various developmental levels. At lowest health development levels (countries with poorer health status), the under-development of economic, health and educational infrastructures creates a vacuum which allows international intervention (aid, investment, export/import activities) to play a dominant role in health status determination. At middle health development levels, health and educational infrastructures are better developed, but still secondary in importance as health status determinants to basic economic infrastructure. Demographic problems are particularly apparent at these levels. At higher health development levels, education, women's status, and political structure are especially important health status determinants. This research has facilitated the identification of health status determinants for use in health policy analysis. Recommendations for future research include use of findings in health policymaking by individual countries and by comparative researchers, and development of appropriate health systems models for each level of health development.
Cross-Cultural Comparison↗
Occupational health in developing countries: review of research needs.
Over the past two decades, industrial activity has increased rapidly in developing nations. Industrial growth has also increased the health risks facing workers in these countries both by intensifying existing health problems and by introducing new hazards. Inadequate information about occupational hazards creates major obstacles to effective prevention of occupational diseases in many developing countries. This brief report reviews the occupational health determinants of developing nations and suggests current research needs and objectives. Our purpose is to stimulate discussion and initiate debate among health professionals worldwide who confront growing problems in occupational health.
Developing Countries↗
[Environment. Preventive health action in the creation of the environment].
The present quantitative importance of prevention is in Switzerland extremely low in comparison to the health budget of the national community. It has taken in recent years increasing place however in speeches and talks as well as in medical thinking. Prevention presently tends to be seen as a medical specialty among others and perhaps prefigures a new form of medicine, the object of which would be the societal body more than the body of the sick individual. In this perspective (would that be good?), a new type of physician-informatician-statistician might be trained, with the mission to manage and supervise the health status of the population. Preventive health action through the environment at large could fulfill an important role in the foreseeable developments. New health "morals" are currently emerging, which are bringing together numerous adepts. This might mean that the time of a "health society" (or health-determined society) is not far.
Attitude to Health↗
Changes in disease patterns and related social trends.
Both the material and non-material aspects of social life are viewed as determinants of major transformations in the patterns of fatal disease and injury. A 'worst case' scenario for the burden of fatal disease is taken as a poor agrarian society precariously dependent on starchy staples and a narrow range of other foods. In such a society life expectancy may be as low as 20. However in many 'pre-modern' societies the regime of roughly matching fertility and mortality levels was set at a 'submaximal' level, with completed fertility rates moderated by marriage conventions. The relative importance of the factors contributing to the historical decline in fatal infection continues to be debated. Evidence on the central role of maternal literacy in the recent decline in Third World mortality suggests the importance of changes in the body of civil society as well as the activities of professionals and public agencies. The decline in fatal infections has been offset to varying extents by an increase in non-communicable disease (NCD): the Mediterranean and East Asia having smaller epidemics of NCDs and Eastern Europe having sustained rises of NCDs. Most industrialised countries have experienced declines in overall NCD mortality in the last 2 decades. Both the fall in fatal infection and the rise and early fall of NCDs can usefully be viewed against the baseline of hunter gatherer cultures. When this is done, the relationship between economic development and disease is seen to be complex. Much 'progress' has been achieved by countering (and then doing better than countering) the adverse effects of earlier developments. Although most members of the generation now alive have experienced marked health benefits from economic and technical advance, it is unclear whether these gains can be both sustained and generalised. It is possible that adverse lagged effects of current industrial (and military) activities will disrupt the habitat of future generations of our species through processes such as stratospheric ozone depletion, global warming and others as yet unpredicted. Modern hygienists have dealt successively with influences on survival mainly operating in early life (infection) and influences operating across the lifespan (determinants of chronic disease). They have now to deal with even greater separations in time and space between potential health determinants and their ultimate effects. To a high level of scientific uncertainty is added the ethical problem of equity between generations.
Cause of Death↗
Health for all: a public health vision.
The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO's multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society--nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals.
Forecasting↗
A descriptive study of early caries and oral health habits of Inuit pre-schoolers: preliminary results.
Despite reports describing the high incidence of baby bottle tooth decay (BBTD) in North American native populations, very little is known about the factors influencing dental health at such an early age. Furthermore, true prevalence figures are usually difficult to obtain because few studies have attempted to survey the whole population. The purpose of this project is to determine the true prevalence of nursing caries in the Kativik region and describe oral health determinants in relation to the dental status of these children. At this time, 244 children aged two to five years have been surveyed. The results indicate that baby bottle tooth decay occur in 72.2% of this young population.
Bottle Feeding↗
[Adolescence at risk: a health survey among pre-university students].
The present study investigates the level of health education in a representative sample of 804 pre-university Asturian students, randomly selected from the official list of the Ministry of Education and Science. We used a questionnaire (designed by us) in order to measure the knowledge, attitudes and behaviour related to some of the most important health determining factors. The survey was carried out by interviewing small groups of students in the classroom situation. Although it was found that the majority perceived themselves as healthy or very healthy, these young people are widely exposed to risk factors: 12% have suffered from more than 25 episodes of drunkenness during the previous year; 43.53% smoked to some extent and only 3.86% identified the days of maximum risk of pregnancy in a supposed menstrual cycle, although 31% maintained sexual relationships. Theoretically, 92% selected health as the most important factor among the three most fundamental values for life. They also think that illegal drugs are the most important health problem at present for young people. There is a contradiction between the high theoretical importance given to health, the good self-qualification of it, and the observed presence of important risk factors. A certain failure of the educational system with respect to primary prevention can be claimed.
Adolescent↗
The Comprehensive Prevention Knowledge and Applications Survey Instrument: its validity and reliability.
Because the instruments used to measure current practices among primary care physicians in a broad range of prevention activities are limited, we developed a study to test a tool that would evaluate current prevention knowledge and applications, including items regarding activities to prevent AIDS and other sexually transmitted diseases. The Comprehensive Prevention Knowledge and Applications Survey Instrument measures knowledge, counseling capabilities, and use of recommended applications in preventive medicine. We designed and tested a 74-item instrument. Four recognized experts in preventive medicine and public health determined its content validity. We then proceeded with reliability testing with a random sample of 315 family physicians and replicated it with an additional 432 physicians for stability reliability. Internal consistency reliability and stability reliability have both been demonstrated for this instrument.
Health Knowledge, Attitudes, Practice↗
Prediction of fatty liver from serum triglyceride levels and body weight indexes.
Fatty liver is a common disease in Taiwan. In this study, we tried to evaluate the validity of predicting the presence of fatty liver from clinical data instead of liver biopsy or sonography. From a community survey in Putai, a total of 873 adults older than 30 years and quantified as to triglyceride level, body height, body weight, and the results of the oral glucose tolerance test and upper abdominal sonography were recruited for analysis. Using a receiver operating characteristic (ROC) curve, the best 'cutoff values' for determination of fatty liver were predicted from body weight index and serum triglyceride level in 8 clusters grouped by sex, age and presence or absence of diabetes mellitus. The best cutoff values of triglyceride in the 8 clusters varied from 100 to 170 mg/dl with worse validity. Most of the values were 130 and 140 mg/dl. The cutoff values of body weight index were constant in all clusters and showed greater validity than those for triglyceride. They were 115% or 120%. Their accuracy for the prediction of fatty liver was positively correlated with its prevalence. However, their accuracy was lower than 70% in non-diabetic females. We conclude that body weight index is a good parameter for prediction of fatty liver especially in the high risk groups and we recommend that health-determining cutoff values of serum triglyceride and body weight index should be set at 130 mg/dl and 115%, respectively.
Adult↗
[Psychophysical status of high school graduates. Results of sociologic studies].
This article intends to describe the present state and development of the psychophysical state of health of GDR graduates. Special attention is given to various quantities influencing the state of health, above all job-related determinants. The empirical basis is an interval study, carried out by the Zentralinstitut für Jugendforschung Leipzig; this study registered and attended hundred of people from the beginning of their studies in 1970 during the following 15 years in seven intervals. Preferably social factors and determinants were studied empirically and partly problematical interrelations between health and working conditions and contents as well as critical development trends of health were pointed out. In this way important starting points for taking measures to influence exogene health determinants were fixed: especially questions of working contents, of correct appointment of graduates corresponding to their profession and qualification, of a permanent training of psycho-physical capabilities.
Adaptation, Psychological↗
[The state of the circulatory system in the elderly].
Fifty six persons (15 men and 41 women) aged between 90 and 99 years were examined to assess their health determining longevity. Circulatory system was evaluated with the aid of anamnesis, physical examination, chest X-ray and ECG. Clinical symptoms of the circulatory disease were diagnosed in 55.4% of tested persons, including: ischaemic heart disease in 42.9%, arterial hypertension in 35.7%, and circulatory failure in 23.2%. Normal ECG records were noted in 10.7% of the tested elderly persons. The most frequent electrographic abnormalities included: decrease in ST, LAH and atrio-ventricular block of the I degree. Incidence of ECG abnormalities did not depend upon the clinical state. An advanced age (over 90 years) is achieved also by the persons with marked circulatory disorders.
Aged↗
[Periodontal status in a group of Swiss soldiers age 28-32 years].
139 soldiers aged 28-32 years of a medical corps unit of the Swiss army were examined for their periodontal conditions. On 3 surfaces of all teeth, plaque deposits were assessed according to the Plaque Index System (Silness and Löe, 1964) and gingival health determined according to the Gingival Index System (Löe and Silness, 1963). Calculus deposits were evaluated on the 6 representative teeth of Ramfjord (1959). On 4 surfaces of the same teeth, pocket depths and loss of attachment were measured. The mean P1I was 1.38, the mean GI 1.11. The mean pocket depth was 2.52, and the mean loss of attachment was 1.38. The results of this study were compared with those of a previous study by Curilović et al. (1972). It was concluded that periodontal disease progressed in the Swiss male population between 20 and 30 years at an annual rate of 0.18 mm loss of attachment despite all the efforts in preventive dentistry.
Adult↗
[Fertility and health in Mexico].
Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.
Family Planning Services↗
Pregnancy outcome in Norway after Chernobyl.
Pregnancy outcome has been studied in terms of legal abortions, early spontaneous abortions and total number of pregnancies (in an ad hoc study covering 6 counties) as well as various perinatal health problems (on the basis of routinely recorded data for epidemiological surveillance from the Medical Birth Registry of Norway). Apparently, no effects were observed in terms of an increased occurrence of legal abortions, while spontaneous abortions increased from 7.2% of all pregnancies during the last 12 months before the accident to 8.3% after the accident [corrected]. At the same time, the total number of pregnancies somewhat decreased. Based on monthly measurements in each municipality of external and internal (food-based) doses, dose-response associations were assessed for a number of perinatal health problems. No associations were observed.
Abortion, Legal↗
Incidence of legal abortions and congenital abnormalities in Hungary.
The annual and monthly distributions of congenital abnormalities and pregnancy outcomes as confounding factors were evaluated in Hungary in reflection of the accident at the Chernobyl reactor. The different congenital abnormality entities and the components of fetal radiation syndrome did not show a higher rate after the Chernobyl accident in the data-set of the Hungarian Congenital Abnormality Registry. Among confounding factors, the rate of induced abortions did not increase after the Chernobyl accident in Hungary. In the 9th month after the peak of public concern (May and June, 1986) the rate of livebirths decreased. Three indicator conditions: 15 sentinel anomalies as indicators of germinal dominant gene mutations, Down syndrome as an indicator of germinal numerical and structural chromosomal mutations, and unidentified multiple congenital abnormalities as indicators of germinal dominant gene and chromosomal mutations were selected from the material of the Hungarian Congenital Abnormality Registry. Diagnoses were checked, familial and sporadic cases were separated and only the sporadic cases were evaluated. The analysis of indicator conditions did not reveal any measurable germinal mutagenic effect of the Chernobyl accident in Hungary.
Abnormalities, Radiation-Induced↗
Reproductive health: a global overview.
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Acquired Immunodeficiency Syndrome↗