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At least 19 recordsLinked to original sources
PubMed1998

What if socioeconomics made no difference?: access to a cadaver kidney transplant as an example.

OBJECTIVES: Several studies have noted the impact of socioeconomic factors on access to expensive medical care, but none of those studies controlled for self-reported health and functional status or attitudes about treatment alternatives when analyses were completed. Because these factors may be correlated with socioeconomic status, the failure to control for them may have led to bias in other studies. The authors merged data from secondary sources with telephone survey data from a national sample of 456 end-stage renal disease patients to show how estimates of the effects of socioeconomic factors change when self-reported health and functional status and attitudes about treatment are incorporated into statistical models. The authors also showed how kidney transplant rates would change if socioeconomic factors no longer influences organ allocation decisions. METHODS: Weibull proportional hazard analyses were used to show relationships between socioeconomic measures and waiting list entry and kidney transplant rates, before versus after accounting for self-reported health and functional status, attitudes about treatment, and other variables. Simulation analyses were used to estimate the number of waiting list spots and transplant operations that would move from economically advantaged to disadvantaged persons if socioeconomics no longer influenced organ allocation decisions. RESULTS: Incorporating information about health and functional status, attitudes about treatment, and other factors into the hazard models often reduced the estimated impact of socioeconomic measures on the odds of (1) being on a waiting list for a cadaver kidney transplant and (2) receiving a transplant. Simulations showed that 30 to 65 waiting list spots or transplant operations per 1,000 patients would shift from economically advantaged to disadvantaged persons if socioeconomics no longer influenced organ allocation decisions. CONCLUSIONS: Successful efforts to level the playing field would result in substantial redistributions of kidney transplants from economically advantaged to disadvantaged persons.

Adolescent↗
PubMed1984

Nestle and breast vs. bottle feeding: mainstream and Marxist perspectives.

The breast vs. bottle feeding issue has sparked a controversial debate. Mainstream analysis of the problem shows that arguments made by the business community, as represented by the Nestle Corporation, do not withstand examination of the evidence. For example, it cannot be substantiated that women begin formula feeding because they have entered the labor force. Mainstream studies of cost effectiveness further indicate that bottle feeding is a drain on the incomes of impoverished Third World families and nations. Marxist analysis gives a very different perspective. Nestle represents 19th century capitalist development and the Industrial Revolution, and 20th century imperialism, neocolonialism and monopoly capitalism. Its motive has been capital accumulation and expansion. To increase surplus value appropriation, capitalism must devalue the household (subsistence) economy in which women enjoyed considerable status. Women also produce the most fundamental commodity for capitalism-laborers; therefore, the biological connection must be masked and controlled for the benefit of capital. Thus, as the capitalist mode of production has developed, women have been removed from important roles in production and reproduction. Coupled with the ascendancy of science, expertism and public health imperialism, breast feeding in any market economy becomes nearly impossible. As women internalize the values of capitalist ideology, they elevate "man-made" marketed commodities over subsistence goods such as breast milk.

Bottle Feeding↗
PubMed1986

An assessment of psychological state associated with the menstrual cycle in users of oral contraception.

Reports of state in relation to the menstrual cycle were investigated using daily measures of state in a group of 65 family planning clinic attenders without pre-existing menstrual complaint. Women reported significant changes in their physical and psychological state prior to menstruation which reverted to "normal' levels 3-5 days after the onset of menstruation. No statistically significant differences were found between the patterns of oral contraceptive users and non-users.

Adolescent↗
PubMed1984

Coronary heart disease and coronary disease risk factors in black populations in underdeveloped countries: the case for primordial prevention.

Coronary heart disease (CHD) is relatively rare in black populations in Africa and is a much less significant cause of morbidity and mortality in black populations in the Caribbean than in U.S. blacks. The incidence of CHD appears to be increasing in segments of some black populations in underdeveloped countries, concurrently with certain patterns of socioeconomic change. Hypertension, hypercholesterolemia, and cigarette smoking are not as common in most of these black populations as in white populations in industrialized countries, although certain affluent groups in African and Caribbean countries have higher levels of some of these risk factors than do the rest of the population. Moreover, the impact on CHD of these risk factors, especially hypertension, appears to be less than is observed in industrialized countries. The absence of mass hyperlipidemia probably accounts for the lower prevalence and incidence of CHD. A policy of primordial prevention of CHD, by control of risk factors and preemptive action to prevent their establishment in the population, has been recommended to Third World governments by a World Health Organization Expert Committee. The need for such a policy, and its applicability in black populations in Africa and the Caribbean, are limited by their socioeconomic situations. Thus for practical purposes, the deteriorating economic situation in the low-income countries (the majority) of sub-Saharan Africa and the Caribbean restricts the possibilities of adverse risk factor changes. In particular, the widespread assumption of the food consumption patterns typical of industrialized countries and the development of mass hyperlipidemia are effectively prevented. In contrast, attempts to foster or maintain desirable food consumption patterns are warranted in middle-income African and Caribbean countries, especially among newly affluent minorities. In all of these territories, primary prevention of hypertension, especially in urban populations, is the ideal approach to the primordial prevention of cardiovascular diseases, of which CHD is a small component.

Adolescent↗
PubMed1983

A comparison of populations self-selected and randomly selected for coronary risk factor screening.

Levels of coronary risk factors in 3,090 adults who sought screening over a 2-year period in Perth, Western Australia, were compared with those in 722 subjects who were selected at random to attend the screening center. Self-referred (SR) subjects were less likely than random-sample (RS) subjects to have suffered from, or be on treatment for, heart disease, hypertension, gout, or diabetes but were more likely to have a family history of premature heart disease. They were less likely to be current smokers and overweight (women only) but more likely to be sedentary at work and have higher mean serum cholesterol levels. SR also had more knowledge about coronary heart disease (CHD) and its causes and were more likely to believe that this knowledge had influenced their behavior, but were less likely than RS to be satisfied with their knowledge level. Smokers among SR were more likely to express a wish to give up smoking than smokers in the RS. These findings are consistent with previous observations. The differences, although statistically significant, were generally small and did not clearly favor one group with respect to total risk of CHD. Therefore the effectiveness of risk factor modification following screening should not be greatly affected by self-selection for screening. Effectiveness may be greater in self-selected subjects because of their apparently greater motivation toward risk factor change.

Adult↗
PubMed1989

Cross-sectional and longitudinal relationships between physical fitness and risk factors for coronary heart disease in men and women: "the Adelaide 1000".

Measurements of aerobic fitness, weight, blood pressure, and lipids were made in 1000 sedentary men and women entering a fitness programme, and were repeated 2 years later in 733 subjects. Cross-sectional analyses including (a) comparisons of CHD risk factors in subjects grouped as "low", "low/moderate", "moderate/high", and "high" fitness, and (b) multiple regression analyses of relationships between fitness and risk factors showed that fitter subjects had better risk profiles than less fit. Longitudinal analyses including (a) comparisons of risk factor changes in subjects grouped as fitness "losers", "stable", "small gain", and "large gain", and (b) multiple regression analyses of relationships between fitness change and risk factor changes showed that fitness change was largely unrelated to risk factor changes. The study supported the existence of beneficial associations between fitness and risk factors but not cause and effect relationships.

Adult↗
PubMed1987

Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring.

This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women.

Epidemiologic investigations have shown that low socioeconomic status is related to ischemic coronary heart disease mortality in men and women as well as to major risk factors for coronary heart disease, predominantly in men. The present study investigated the associations between educational attainment and biologic and behavioral risk factors for coronary heart disease in a community sample of 2,138 middle-aged women residing in Allegheny County, Pennsylvania. The women were contacted between 1983 and 1985 to determine eligibility for a study of risk factor changes during the perimenopausal period. Eligibility criteria included age 42 to 50 years, premenopausal status, diastolic blood pressure less than 100 mmHg, and nonuse of medications known to influence risk factors. Among the 541 eligible participants, the less education the women reported, the more atherogenic was their risk factor profile, including higher systolic blood pressure, low density lipoprotein (LDL) cholesterol, apolipoprotein B, triglycerides, fasting and two-hour glucose values, two-hour insulin values, body mass indices, and lower high density lipoprotein (HDL) cholesterol and HDL/LDL ratio; the more often they reported being cigarette smokers, taking little physical exercise, and consuming alcohol less than one day a week; the more often they reported on standardized psychologic tests being Type B, angry, pessimistic, depressed, and dissatisfied with paid work, and having little social support and self-esteem (all p values less than 0.01). Similar associations were obtained between educational attainment and risk factors reported by the 1,588 nonparticipants during the telephone screening interview. These results suggest many biologic and behavioral factors by which women with little education are at elevated risk for coronary heart disease. To the extent that advanced education protects women against coronary heart disease, a potentially important public health intervention for women is education.

Adult↗
PubMed1994

Declining cardiovascular disease incidence and environmental components.

After rising for many years in the mid-to-late 1930s the mortality from ischaemic heart disease (IHD) began to decline in many countries. This represents a decline in both out-of-hospital (community) and hospital deaths. Non-fatal myocardial infarction (MI) has also declined. A literature review was conducted to examine lifestyle and environmental factors contributing to the decline. Half of the decline is attributable to changes in lifestyle and in the known major risk factors. Changes in nutrition appear relevant to the decline, in particular an increased ratio of polyunsaturated to saturated fat intake and a reduced saturated fat intake overall. There is little evidence to support a role of changing alcohol consumption, changing coffee consumption, changing exercise levels or reduction in excess weight in the declining incidence of IHD. While the benefit of smoking cessation is a clear one, its impact on the differing trends in various countries is not clear. Socio-economic factors appear to influence the rate and extent of decline in IHD in different groups and may help explain some of the regional differences in IHD incidence. Reductions in blood pressure within the 'normal range' which may occur with lifestyle changes may also be an important contributor.

Adult↗
PubMed1995

The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

OBJECTIVES: Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS: Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs. RESULTS: The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation. CONCLUSIONS: The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs.

Adolescent↗
PubMed1982

[Obesity in childhood].

It is impossible to make general statements on obesity, and apply them to all adipose patients. These statements can be more or less valid for various populations of obese subjects depending on the definition of obesity chosen. Obesity in infancy should not be disregarded, although it has not been proven that obese infants become obese adults, whereas obese adolescents tend to remain obese. Obesity is genetically determined yet exogenous factors are more or less necessary for its development. The significance of risk factors changes during childhood, depends on the gender, and varies with different populations. The hypothesis that obese patients have a diminished thermogenesis should be considered although it is not clear whether this applies to all obese patients. Research on disregulation of appetite could result in further clarification of the pathogenic mechanism causing obesity. Treatment of obesity is necessary in patients with 120% or more overweight related to height, preferably before age of 7 years to take advantage of further growth as a regulating factor.

Adolescent↗
PubMed1994

[Effects of an educational campaign on cardiovascular risk factors in a French town (Epernon, study town). Methods and preliminary results: prevalence and level of risk factors].

The authors report the methods and preliminary findings of a study scheduled to last 5 years, which aims to evaluate cardiovascular risk factor changes in response to an education program. The population sample consisted of 961 subjects, from Epernon itself (the study town) and from two control towns. The assessment criteria were reported at the beginning of the study and then again after 2 and 5 years. They consisted of an analysis of medical events and of biomedical and dietary data and a detailed analysis of behavior with regard to health and socio-economic variables. Preliminary data show that the samples were similar in Epernon and the control towns and also comparable to some French epidemiological data. There is a striking difference between the percentage of subjects aware of their blood pressure (65.5%) and blood cholesterol (13.4%) levels.

Adult↗