Relations between individual and neighborhood-based measures of socioeconomic position and bone lead concentrations among community-exposed men: the Normative Aging Study.
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To examine the association between lead exposure and both individual and geographic area indicators of socioeconomic position, the authors measured tibia lead concentration, a biomarker of cumulative lead exposure, using K x-ray fluorescence in a cross-sectional survey of 538 white males aged 50-92 years who were healthy when enrolled in the Normative Aging Study (Boston, Massachusetts) in the 1960s. Data on individual risk factors, education, occupation, and income were collected by questionnaire. Using subjects' residential addresses at the time of the tibia lead measurements, the authors obtained geographic area-specific measures of education, social class, and poverty by linking records to 1990 US Census block group data. In multivariate linear regression analysis controlling for age and cumulative smoking, tibia lead concentrations were 10.39 microg/g (95% confidence interval (CI) 7.80-12.97) higher in men who did not graduate from high school than in men with > or =4 years of college. Among the former men (non-high school graduates), living in an undereducated area was associated with a 9.28 microg/g (95% CI 1.59-16.97) increase in tibia lead level compared with living in a non-undereducated area; among the latter men (college graduates), no difference existed by residential area education (beta = 0.72, 95% CI -5.35 to 6.78). The authors conclude that the influence of individual socioeconomic position on cumulative lead exposure is modified by geographic area conditions. (+info)
Objectives, methods and content of patient education programmes for adults with asthma: systematic review of studies published between 1979 and 1998.
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BACKGROUND: Education programmes for adults with asthma vary widely. Such variability suggests a lack of consensus on what works and what does not. The objectives of this paper are to describe asthma education programmes and assess their variability. METHODS: A systematic review of reports published between 1979 and 1998 was conducted. Medline, the CINAHL database, the PsycINFO database, the Cochrane collaboration database, the Dissertation Index database, and cross referencing were used to identify educational interventions; 77 projects including 94 interventions that involved 7953 patients were analysed. A standard form was used to record characteristics of studies (design, setting, size, year, and country of publication), projects (theoretical framework, objectives), and education (methods, duration, intensity, educator, and content). RESULTS: Most reports did not specify the general (56%) and educational objectives (60%) of the intervention. Important training characteristics were often not available: duration of education (45%) and number of sessions (22%), who delivered education (15%), whether training was conducted in groups or was individualised (28%). When this information was available there were wide variations in training methods and content: training duration ranged from 0 (self-education) to 58 hours and the number of sessions from 0 to 36; training tools such as peak flow meters, diary cards or books were used in various proportions of interventions (19%, 27%, and 23%, respectively). The content of education also differed widely between programmes. CONCLUSIONS: Insufficient documentation of asthma education programmes for adults precludes their replication. This, together with excessive variability, reduces the possibility of identifying their most effective components. A more systematic description of asthma training programmes should be promoted. (+info)
The epidemiological impact of antimeningococcal B vaccination in Cuba.
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The incidence of invasive meningococcal disease (IMD) before (1984-1988) and after (1989-1994), a nationwide intervention with VA-MENGOC-BC vaccination started in 1989, was compared. The prevaccination period incidence density (ID> 8.8/10(5) year-person) was higher than the postvaccination ID (ID< 6.5/10(5) year-person). The percentage proportional differences from the start to the end of each period of ID in the vaccinal period was higher (87%) than the prevaccinal (37%) with significant differences among vaccinated groups (< 25 years old). A break-point (Chow test) was confirmed by the decrease in the ID between 1989 and 1990 in children under 1 year old, 5-9, 10-14, 15-19 and 50-54 years. Comparison of ID using maps showed a decrease in IMD in all municipalities during the postvaccination period. These findings support the epidemiological impact of VA-MENGOC-BC vaccination in the reduction of IMD morbidity. (+info)
Do the factors associated with successful contact tracing of patients with gonorrhoea and Chlamydia differ?
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OBJECTIVE: To assess and compare factors which may be associated with successful contact tracing in patients with gonorrhoea and chlamydia. STUDY DESIGN: Prospective observational study of patients attending a genitourinary medicine clinic with a diagnosis of gonorrhoea or chlamydia. Multivariate analysis model including demographic, socioeconomic, and behavioural variables. RESULTS: The attendance of at least one sexual contact was associated with naming more contacts for patients with gonorrhoea (OR 1.44, 95% CI 1.04-2.01). A history of gonorrhoea was associated with successful contact tracing for patients with chlamydia (OR 1.46, 95% CI 1.12-1.9). Successful contact tracing, as defined by at least one confirmed contact attendance after the index case, was not associated with age, sex, sexual orientation, history of chlamydia, use of condoms, marital status, ethnicity, or socioeconomic status for either gonorrhoea or chlamydia. CONCLUSIONS: Differences in the composition of the core groups infected with gonorrhoea and chlamydia are not explained by differences in contact tracing success. In the clinic setting studied, the outcome of contact tracing was not associated with a variety of demographic, socioeconomic, and behaviour factors. (+info)
Mortality from Alzheimer's disease: an update.
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Alzheimer's disease is a progressive degenerative condition that has devastating implications for those afflicted. An estimated 4 million Americans, mainly elderly, have this condition, which is characterized by forgetfulness in early stages and increasingly severe debilitating symptoms as the disease progresses over what can be as long as a 20-year period. As an individual's impairment increases, informal or formal care giving becomes necessary to take care of basic needs. Annually, an estimated $80 to $100 billion dollars are spent on health care expenses or lost in wages for the persons with Alzheimer's disease or their care givers. At later stages of the disease, persons with Alzheimer's disease are bedridden and vulnerable to developing other medical conditions and dying before they would if they did not have Alzheimer's disease (1). Physicians report that Alzheimer's disease caused the death of 21,397 persons in 1996 and contributed to the death of 21,703 additional persons. This information is from death certificates completed by physicians for all deaths in the United States, a fundamental source of information on what caused death for the 2.3 million deaths in the United States. The risk of dying from Alzheimer's disease has leveled off in recent years after rapid increases in the early 1980's and subsequent slower growth in the 1990's. The trend likely reflects changes in attitudes of physicians and the public about attributing Alzheimer's disease as a cause of death as well as the availability of improved diagnostic procedures; the recent leveling in mortality trends from this condition may signal that death certificate diagnoses for Alzheimer's disease are more reliable now. Alzheimer's disease is a major cause of death, which exhibits variations by age, sex, race, and geographic area. This report provides recent mortality data on Alzheimer's disease. A previous report covers historic trends (2). (+info)
Who has screening mammography? Results from the 1994-1995 National Population Health Survey.
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OBJECTIVE: To determine the characteristics of Canadian women aged 35 to 49 who receive screening mammograms not recommended by the Canadian Task Force on the Periodic Health Examination. DESIGN: Secondary data analysis of the 1994-1995 National Population Health Survey. SETTING: Patients' homes. PARTICIPANTS: From a full national representative sample of 17,626 Canadian residents, we selected 2053 women aged 35 to 49 with no breast problems. MAIN OUTCOME MEASURES: Age, education, employment status, marital status, immigrant status, region of residence, self-reported health status, having a regular doctor, smoking status, alcohol consumption, and having a confidant. RESULTS: Of the 2053 women in the sample, 825 (40.2%) had had a screening mammogram as part of a regular medical checkup; 1228 (59.8%) had never had one. Logistic analysis showed that respondents who were approaching age 50, had higher incomes, lived in Quebec, and had regular medical doctors were more likely to have screening mammograms. Statistical trends indicated that heavy drinkers were less likely and immigrants more likely to have mammograms (not significant at P < .01: P = .012 and P = .02, respectively). CONCLUSIONS: Most of these findings are consistent with those of other studies of women 50 and younger. The findings suggest that the patient variables associated with having mammograms in those younger than 50 might be similar to those in women older than 50. An important next step is to determine whether this pattern of use has more to do with younger patients' demand for screening or with physicians' ordering of tests. Further research is also needed to understand the dynamics of the doctor-patient relationship in this situation. (+info)
A continuing focus of Hansen's disease in Texas.
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To describe epidemiologic and clinical characteristics of Hansen's disease cases in Texas, information was abstracted from records of 810 patients reported from 1973 through 1997. Annually, from 18 to 54 patients were reported. Average annual incidence rates ranged from 1.9 to 2.4 cases per million population. A majority of the patients were male (63%) and white (77%). More than half (53%) of the patients were born in the United States; a majority (83%) of the patients born in the United States were born in Texas. Most (76%) patients were diagnosed with multi-bacillary leprosy. Foreign-born patients were more likely to be younger at onset and have multi-bacillary disease compared with patients born in the United States. Within Texas, an endemic focus of Hansen's disease exists along the Gulf of Mexico coast. (+info)
Prevalence of self-reported nutrition-related health problems in the Lower Mississippi Delta.
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OBJECTIVES: The purpose of this study was to assess demographic and geographic differences in prevalence of self-reported nutrition-related health problems in Arkansas, Louisiana, and Mississippi. METHODS: The authors analyzed 1991 and 1993 Behavioral Risk Factor Surveillance System data for adults 18 years or older. RESULTS: Less educated African American women and women of other minority groups who were aged 35 to 64 years reported the highest prevalence of health problems. Geographic differences involved prevalence of hypertension, health status, and insurance status. CONCLUSIONS: Specific demographic subgroups and geographic areas with a high risk of health problems are in particular need of targeted interventions. (+info)