Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK.
BACKGROUND: Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation. This study reports clinical outcomes and quality of life from a community based project investigating white European (W/E) and Indian subcontinent (ISC) ethnic groups with asthma living in deprived inner city areas of Birmingham, UK. METHODS: Six hundred and eighty nine asthmatic subjects (345 W/E, 344 ISC) of mean (SD) age 34.5 (15) years (range 11-59) and mean forced expiratory volume in one second (FEV(1)) of 80% predicted were interviewed in English, Punjabi, Hindi, or Urdu. Subjects randomised to the active limb of a prospective, open, randomised, controlled, parallel group, 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up (active intervention). Control groups were seen only at the beginning and end of the study. Urgent or emergency interactions with primary and secondary health care (clinical outcomes) and both cross sectional and longitudinal data from an Asthma Quality of Life Questionnaire (AQLQ) were analysed. RESULTS: Clinical outcomes were available for 593 subjects. Fewer of the active intervention group consulted their GP (41.8% versus 57.8%, odds ratio (OR) 0.52 (95% CI 0.37 to 0.74)) or were prescribed antibiotics (34.9% versus 51.2%, OR 0.51 (95% CI 0.36 to 0.72)), but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits. Active intervention reduced the number of hospital admissions (10 versus 30), GP consultations (341 versus 476), prescriptions of rescue oral steroids (92 versus 177), and antibiotics (220 versus 340), but again significant improvements by ethnicity only occurred in the active W/E group. AQLQ scores were negatively skewed to the higher values; regression analysis showed that lower values were associated with ISC ethnicity. Longitudinal changes (for 522 subjects) in the mean AQLQ scores were small but statistically significant for both ethnic groups, with scores improving in the active and worsening in the control groups. CONCLUSIONS: Active intervention only improved clinical outcomes in the W/E group. AQLQ scores, although lower in the ISC group, were improved by active intervention in both ethnic groups. (+info)
Joining together to combat poverty.
The International Poverty and Health Network (IPHN) was created in December 1997 following a series of conferences organized by the World Health Organization, with the aim of integrating health into plans to eradicate poverty. Around 1.3 billion people live on less than US$1 per day. Of the 4.4 billion people in developing countries nearly 60% lack access to sanitation, 30% do not have clean water, 20% have no health care, and 20% do not have enough dietary energy and protein. Even among rich nations there are gross socioeconomic inequalities. Many children are robbed of their physical and mental potential through poverty. Expressed in constant 1963 US dollars, an average Croatian family needed the annual income of US$894 to meet the poverty line in 1960 and US$9,027 in 1995. Accordingly, 9-25% of Croatian households were below the poverty line between 1960 and 1995. The increase in the poverty rate after 1991 was compounded by the war that destroyed almost a third of industrial capacity and infrastructure. Dissipation of the communist economy and inadequate privatization have contributed to the increase in unemployment rate, corruption, and other social ills. IPHN invited Croatian Medical Journal to publish this editorial to help push the issue of poverty up political and medical agendas on a global level. We argue that a factor contributing to the failure of most large-scale programs against poverty to date is the excessive emphasis on material and infrastructure assistance at the expense of spiritual, moral, and intellectual development. (+info)
Perceived aesthetic impact of malocclusion and oral self-perceptions in 14-15-year-old Asian and Caucasian children in greater Manchester.
The aims of this study were to evaluate (i) the effect of ethnicity, social deprivation, and normative orthodontic treatment need on orthodontic aesthetic self-perception, self-perceived need for orthodontic treatment, and oral aesthetic impact of malocclusion; (ii) the effect of ethnicity, social deprivation, and gender on perceived orthodontic treatment need and use of orthodontic services; (iii) the influence of perceived oral aesthetic impact of malocclusion on perceived need and wish for orthodontic treatment; and (iv) whether orthodontic treatment experience influences perceived oral aesthetic impact of malocclusion. A stratified, random sample of 434 14-15-year-old children from schools in Manchester, UK, was obtained. Information was collected on orthodontic aesthetic self-perception and orthodontic treatment experience using a questionnaire. The former data were combined to form an Oral Aesthetic Subjective Impact Scale (OASIS). Normative orthodontic treatment need was measured with the Index of Orthodontic Treatment Need (IOTN). Children with higher clinical need for orthodontic treatment perceived themselves as worse off than their peers with lower need. More socially deprived children or those with high IOTN aesthetic component (AC) scores had a higher (i.e. more negative) aesthetic impact (OASIS) score. Asians and females had higher IOTN dental health component (DHC) scores, but a better aesthetic appearance than Caucasians and males. More deprived children were less likely to have received orthodontic treatment. Despite this, OASIS scores were similar between treated and untreated children. Untreated children who wished for orthodontic treatment had higher IOTN AC and OASIS scores. (+info)
Hitting the target: the equitable distribution of health visitors across caseloads.
BACKGROUND: Health visitors in the United Kingdom work mainly with pre-school children and their mothers. Their distribution across the population is largely historical, highly variable and relates poorly to indicators of population need. METHODS: A range of largely routine data sources were used to describe the nature, variation and statistical determinants of the workload of individual health visitors in Sheffield, England, in 1996-1997. Regression models were tested relating measures of need and deprivation to the total number of client contacts. RESULTS: Caseloads were smaller in the most deprived areas, with wide variation. Most (93 per cent) contacts were with mothers and young children. Health visitors visited the clients designated as highest priority on average 4.7 times more often than routine clients. The main reasons for high priority ratings were child protection concerns, maternal mental health problems, child development and health concerns, and first-time mothers in the postnatal period. Half of all client contacts were with low-priority families for routine child health surveillance or were client initiated. Models based on the number of children under five and any one of a range of measures of social deprivation account for 57-59 per cent of variation in workload and could be used to allocate resources more equitably. CONCLUSIONS: Although most health visitors apparently subscribe to the principle of targeting, the extent varies widely. Constraints on targeting are routine child health surveillance reviews, and client demands. More equitable allocation of health visitors and more explicit targeting policies might increase the effectiveness of the health visiting service. (+info)
How well do socio-demographic characteristics explain variation in childhood safety practices?
BACKGROUND: Unintentional injury is the leading cause of death in children older than 1 year. Deaths from accidents have a steeper class gradient than any other fatal condition and this inequality is widening. There are few published data on the relationship between safety practices and sociodemographic characteristics, hence this study has been undertaken to examine this relationship. METHODS: The study population comprised all parents and guardians of children aged 3-12 months in 36 practices throughout Nottingham (n = 2,152). A postal questionnaire was used to survey current childcare safety practices (from which safe practices scores were derived), together with socio-demographic variables and known risk factors for childhood unintentional injury. RESULTS: Unsafe childcare practices were common. Socioeconomically disadvantaged families had more unsafe practices than more affluent families, but few parents undertook safe practices all the time. The child's age (p<0.01), ethnicity (p<0.01) and living in non-owner-occupied accommodation (p<0.01) were independently associated with the safe practices score. Multivariate regression modelling showed that these risk factors explained only 11 per cent of the variation in the safety practices score. Socio-economic factors explained more of the variation in possession and use of items of safety equipment (13 per cent) than the variation in safety behaviours with no cost implications (3 per cent). CONCLUSIONS: Most of the variation in the number of safety practices is not explained by socio-demographic characteristics and further work is required to examine other possible determinants of safe practice. (+info)
Does the multidimensional nature of Super Profiles help district health authorities understand the way social capital affects health?
BACKGROUND: Social capital describes the notion that the social processes in an area can lead to benefits in health. As Super Profiles describe the social character of an area and they are easy for health authorities to use, they could provide a simple method for local assessment of how social organization affects health. METHODS: We calculated the expected mean birthweight for the enumeration districts of Birmingham based upon marital status, registration details of the child, year of birth, the mother's country of birth, fetal sex and deprivation as judged by the Townsend score using data from 138,696 live-born singleton births for the years 1986-1996 inclusive. We classified enumeration districts into Target Markets, derived from Super Profiles. For each Target Market, we calculated the observed mean birthweight and the difference and 95 per cent confidence interval between the observed and expected birthweights. We used information in Super Profiles to speculate about the social processes that led to some Target Markets having mean birthweights that were significantly different from those expected. RESULTS: Fifteen of the 40 Target Markets had significant differences between predicted and observed mean birthweight, but these differences were less than 50 g. There were no common characteristics of Target Markets that were consistently advantageous for birthweight and none that were disadvantageous. CONCLUSION: The information in the Super Profiles does not illuminate the way that social processes affect health, and the variation in mean birthweight between areas explained by social processes as measured by Super Profiles is small. (+info)
What common disorders do those reporting limiting long-term illness experience, and what is their survival and health service utilization experience?
BACKGROUND: The aim of this study was to examine the relationships between self-reported limiting long-term illness and other disease-specific symptoms, mortality and use of hospital services. METHODS: A cohort generated by population health survey was linked to information on mortality and health service use, in Sheffield, England, 1994-1998. Limiting long-term illness was assessed using the 1991 Census question wording; specific symptoms were assessed using standard instruments; other outcomes were admission to hospital and mortality. RESULTS: Limiting long-term illness is stated more commonly than in the Census, especially in males and in the young. It is commoner in the presence of some conditions such as angina much more than in others such as gastrointestinal disease. For all age groups, both mortality and, to a lesser extent, hospital admission rates are higher in those responding yes to the long-term illness question. CONCLUSIONS: Limiting long-term illness assessment from the Census acts as a better proxy for some aspects of population health than others although it may underestimate the absolute prevalence. Although it may be of use in identifying relative needs, mortality is associated more strongly with differences in limiting long-term illness than is health service utilization. This may be as much a result of mismatch between use and need as of any deficiency of the measure itself. (+info)
Predicting population dental disease experience at a small area level using Census and health service data.
BACKGROUND: Information on the dental disease patterns of child populations is required at a small area level. At present, this can be provided only by expensive whole population surveys. The aim of this study was to evaluate the ability of Census data combined with health service information to provide estimates of population dental disease experience at the small area level. METHOD: Clinical dental data were collected from a large cross-sectional survey of 5-year-old children. A preliminary series of bivariate linear regression analyses were undertaken at ward level with the mean number of decayed, missing or filled teeth per child (dmft) as the dependent variable, and the Census and health service and lifestyle variables suspected of having a strong relationship with dmft as independent variables. This was followed by fitting a multiple linear regression model using a stepwise procedure to include independent variables that explain most of the variability in the dependent variable dmft. RESULTS: All deprivation indicators derived from the Census showed a highly significant (p<0.001) bivariate linear relationship with ward dmft. The Jarman deprivation score gave the highest R2 value (0.45), but the Townsend index (R2=0.43) and the single Census variable 'percentage of households with no car' (R2 = 0.42) gave very similar results. The health and lifestyle indicators also showed highly significant (p<0.001) linear relationships with dmft. The R2 values were generally much lower than the deprivation-related Census variables, with the exception of the percentage of residents who smoked (R2 = 0.42). None of the health or lifestyle variables was included in the final dental disadvantage model. This model explained 51 per cent of the variability of ward dmft. CONCLUSIONS: The results demonstrate the strong relationship between dental decay and deprivation, and all of the commonly used measures of deprivation exhibited a similar performance. For this population of young children health and health services shelf data did not improve on the ability of deprivation-related Census variables to predict population dental caries experience at a small area level. (+info)