Trajectories of fetal loss in the Czech Republic.
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Using data for 555,038 pregnancies conceived in the Czech Republic in 1987-1990, we show that pronounced differences in fetal survival in the middle trimester of pregnancy by marital status, educational level, and labor force attachment become much smaller at full term; survival differences by age at conception and number of previous deliveries show relatively constant proportional hazards throughout gestation. Social inequalities in postpartum life chances have been documented previously, but we show that similar inequalities exist before birth. (+info)
Trends in perceived cost as a barrier to medical care, 1991-1996.
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OBJECTIVES: This study examined trends in perceived cost as a barrier to medical care. METHODS: The Behavioral Risk Factor Surveillance System was used to analyze monthly telephone survey data from 45 states. RESULTS: Overall, the percentage of persons perceiving cost as a barrier to medical care increased from 1991 until early 1993 and then declined to baseline values in late 1996. Perceived cost was a greater barrier in 1996 than in 1991 for persons with low incomes and for those who were unemployed and uninsured. For self-employed persons, percentages increased until mid-1993 and then remained constant. CONCLUSIONS: Further efforts are needed to improve access to medical care for socially disadvantaged populations. (+info)
Genetic and environmental influences on eating patterns of twins aged >/=50 y.
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BACKGROUND: Clinicians and researchers could benefit from a greater understanding of the role of genetic and environmental factors in human eating behavior. OBJECTIVE: Our aim was to estimate the relative influence of genetic and environmental factors on habitual eating patterns in middle-aged and elderly men and women. DESIGN: Male and female twins (n = 4640) aged >/=50 y completed a mailed version of the National Cancer Institute food-frequency questionnaire. Factor analysis was performed to identify eating patterns among respondents. Estimates of genetic, common environmental (shared by family members), and specific environmental (unique to an individual) influences were obtained for food use, serving size, and consumption frequency by comparing monozygotic and dizygotic twin-pair groups with structural equation analysis. RESULTS: Two independent eating patterns were identified: the first consisted of items high in fat, salt, and sugar, and the second reflected healthful eating habits. Although the influence of environmental factors was larger, between 15% and 38% of the total variation in pattern 1 and between 33% and 40% in pattern 2 were explained by genetic influences. Models accounting for sex differences in genetic and environmental estimates fit the data significantly better for food use and serving size of foods in eating pattern 1 and for food use in eating pattern 2. CONCLUSION: Although 60-85% of the variability in eating patterns was associated with environmental factors, genetic influences were also apparent and there was some evidence of sex specificity. These findings may be important in crafting dietary interventions and predicting adherence to these interventions. (+info)
Nonfatal physical violence, United States, 1994.
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OBJECTIVES: Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US. METHODS: The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been "hit, slapped, pushed, or kicked by another person or hit with an object or weapon" in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment. RESULTS: The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention. CONCLUSIONS: Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year. (+info)
Link between the CSF shunt and achievement in adults with spina bifida.
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OBJECTIVES: A few enterprising adults with shunt treated spina bifida live independently in the community, have a job in competitive employment, and drive to work in their own car. By contrast others with similar disability but lacking their motivation remain dependent on care and supervision. The aim of this study was to identify events in the history of their shunt which may have influenced their subsequent achievement. METHODS: Between June 1963 and January 1971 117 babies born in East Anglia with open spina bifida had their backs closed regardless of the severity of their condition. When reviewed in 1997 every case was ascertained. Sixty had died and the 57 survivors had a mean age of 30. These were assigned to two groups: achievers and non-achievers, according to their attainments in independence, employment, and use of a car. RESULTS: Of the 57 survivors nine had no shunt and eight of these were achievers. All were of normal intelligence (IQ>/=80) and only one was severely disabled. Of the 48 with shunts only 20 were achievers (OR 11.2, 95% confidence interval (95% CI) 1.3-96.8). Lack of achievement in these 48 was associated with revisions of the shunt, particularly when revisions were performed after the age of 2. Sixteen patients had never required a revision and 11 (69%) were achievers; 10 had had revisions only during infancy and five (50%) were achievers; 22 had had revisions after their second birthday and only four (18%) were achievers (p<0.001). Elective revisions were not performed in this cohort and in 75% of patients revisions had been preceded by clear symptoms of raised intracranial pressure. CONCLUSION: Revisions of the shunt, particularly after the age of 2, are associated with poor long term achievement in adults with spina bifida. (+info)
Work practices and histopathological changes in the tenosynovium and flexor retinaculum in carpal tunnel syndrome in women.
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We studied 58 women of employable age with the carpal tunnel syndrome in order to determine whether the histological appearances of the carpal tunnel, tenosynovium and flexor retinaculum are influenced by work practices. Age, body mass index and the duration of symptoms did not correlate with the extent of oedema or fibrosis within the tenosynovium. The incidence of abnormality on histological examination of the tenosynovium was the same in employed and unemployed patients (p = 1.0), and was not influenced by the level of repetition (p = 0.89) or force (p = 0.29) of work. Myxoid degeneration within the flexor retinaculum was, however, more common in women undertaking 'high-force' work. Apart from this finding, the results suggest that work practices do not affect tenosynovial thickening, fibrosis or oedema in patients with carpal tunnel syndrome. (+info)
Medical informatics education: the University of Utah experience.
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The University of Utah has been educating health professionals in medical informatics since 1964. Over the 35 years since the program's inception, 272 graduate students have studied in the department. Most students have been male (80 percent) and have come from the United States (75 percent). Students entering the program have had diverse educational backgrounds, most commonly in medicine, engineering, computer science, or biology (59 percent of all informatics students). A total of 209 graduate degrees have been awarded, with an overall graduation rate of 87 percent since the program's start. Alumni are located in the United States (91 percent) and abroad (9 percent); half (51 percent) have remained in Utah. Former students are employed in a wide variety of jobs, primarily concerned with the application of medical informatics in sizable health care delivery organizations. Trends toward increasing managerial responsibility for medical informatics graduates and the emergence of the chief information officer role are noted. (+info)
Stroke location is not associated with return to work after first ischemic stroke.
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BACKGROUND AND PURPOSE: In prior studies, age, race, job category, disability, and cortical functions such as praxis, language, and memory have been associated with vocational outcome, but the influence of stroke location on return to work has never been critically examined. METHODS: We examined the influence of stroke location on vocational outcome in patients with clinically confirmed acute ischemic stroke from the National Institute of Neurological Disorders and Stroke Stroke Data Bank. RESULTS: Of 143 patients working full time at the time of first ischemic stroke, 23 patients were dead and 120 were alive at 1 year. Employment status was known in 109 (mean age, 55 years; 51 [47%] were white, and 82 [75%] were male). Fifty-eight (53%) had returned to work; most (85%) worked full time. Younger age was positively associated with return to work (P<0.05). In an age-adjusted analysis, stroke severity as measured by the Barthel Index 7 to 10 days after stroke was negatively associated with return to work (P<0.001). Higher household income and absence of cortical neurological dysfunction 7 to 10 days after stroke were positively but less strongly associated with return to work (P<0.08). Stroke location, sex, and depression at time of stroke were not associated with vocational outcome. CONCLUSIONS: Our data suggest that stroke location may be less important than other more easily measured factors in predicting vocational outcome. (+info)