Differences In Health Conditions Research Articles

Differences in functioning of individuals with tetraplegia and paraplegia according to the International Classification of Functioning, Disability and Health (ICF)

Cross-sectional, multicenter study. To identify and quantify the differences in functioning of individuals with tetraplegia versus paraplegia using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. International. Functional problems of 1048 participants with spinal cord injury in 16 study centers in 14 countries were recorded using ICF categories. The level of significance and odds ratios (OR) for experiencing each of these functional problems were reported for individuals with tetraplegia and paraplegia. Regression models were adjusted for age, age squared, early post-acute or long-term context, gender and for world regions. Persons with tetraplegia are more at risk than persons with paraplegia to have difficulties in 36.4% categories of the component body functions. In the component body structures, 40% of the categories show significant differences. Individuals with tetraplegia indicate problems in three categories, whereas individuals with paraplegia are more likely to indicate problems in one category. Most categories indicating difficulties (56.6%) for persons with tetraplegia were found for the component activities and participation. The component with the highest congruency was the environmental factors. Overall, 3.7% categories (of the persons with tetraplegia as experienced, 2.4% of the categories as barriers, whereas 4.9% were experienced to be facilitators) obtained OR, indicating individuals with tetraplegia having more difficulties. The logistic regression analysis identified a variety of differences in functional problems in individuals with tetraplegia compared with individuals with paraplegia. The ICF has the potential to indicate the differences in health conditions.

Personality traits and subjective health in the later years: The association between NEO-PI-R and SF-36 in advanced age is influenced by health status

This study examined the association between personality traits (as measured by the NEO-PI-R) and subjective ratings of mental and physical health (as measured by the SF-36) in two samples of older adults differing in health status (Baltimore Longitudinal Study of Aging, BLSA, n = 393, vs. Medicare Primary and Consumer-Directed Care Demonstration, Medicare PCC, n = 648). The association between personality traits and subjective mental health did not differ significantly across samples. The association between personality and subjective physical health, however, was significantly stronger in the healthy BLSA sample than in the medically challenged Medicare PCC sample. Differences in health conditions and recent hospitalizations partially accounted for this effect. Lifespan developmental considerations and implications for the use of subjective health ratings as outcome measures in clinical studies are discussed.

Gender systems and/in the Spanish National Health Interview Survey

OBJECTIVE: To analyze the Spanish National Health Interview Survey (NHIS) from a gender perspective, with special emphasis on gender division of labor. METHOD: We analyzed the 2003 Spanish NHIS from the perspective of the levels of gender observation, with gender understood as: a) the basis of social norms (responsibilities by sex, health risks, and problems related to masculine/feminine roles); b) the organizer of the social structure: gender division of labor, work overload, vertical/horizontal segregation, time spent in activities according to social times, access to resources), and c) a component of individual identity (conflicts due to multiple roles, body image dissatisfaction, self-esteem, self-perceived recognition of the work performed, assimilation of the sexual gender role, sex differences in health conditions). RESULTS: The Spanish NHIS is centered on the main provider, referred to in masculine grammatical form. Gender division of domestic labor is identified only by a general question. When using the concept of main activity for productive or reproductive work, the survey requires respondents to evaluate them and select only one, thus losing information and hampering analysis of the impact of an overload of work on health. Information on time used for reproductive work and leisure is not solicited. Assaults (intentional) and accidents (non-intentional) are combined in the same question, thus preventing research on gender-related violence. CONCLUSIONS: The Spanish NHIS includes the variable of sex, but its more descriptive than analytic focus limits gender analysis. The survey allows specific circumstances of employment-related inequalities between sexes to be measured, but does not completely allow other indicators of gender inequalities, such as the situation of housewives or work overload, to be measured. Language: es

Los sistemas de género y/en la Encuesta Nacional de Salud

ObjectiveTo analyze the Spanish National Health Interview Survey (NHIS) from a gender perspective, with special emphasis on gender division of labor. MethodWe analyzed the 2003 Spanish NHIS from the perspective of the levels of gender observation, with gender understood as: a) the basis of social norms (responsibilities by sex, health risks, and problems related to masculine/feminine roles); b) the organizer of the social structure: gender division of labor, work overload, vertical/horizontal segregation, time spent in activities according to social times, access to resources), and c) a component of individual identity (conflicts due to multiple roles, body image dissatisfaction, self-esteem, self-perceived recognition of the work performed, assimilation of the sexual gender role, sex differences in health conditions). ResultsThe Spanish NHIS is centered on the main provider, referred to in masculine grammatical form. Gender division of domestic labor is identified only by a general question. When using the concept of main activity for productive or reproductive work, the survey requires respondents to evaluate them and select only one, thus losing information and hampering analysis of the impact of an overload of work on health. Information on time used for reproductive work and leisure is not solicited. Assaults (intentional) and accidents (non-intentional) are combined in the same question, thus preventing research on gender-related violence. ConclusionsThe Spanish NHIS includes the variable of sex, but its more descriptive than analytic focus limits gender analysis. The survey allows specific circumstances of employmentrelated inequalities between sexes to be measured, but does not completely allow other indicators of gender inequalities, such as the situation of housewives or work overload, to be measured.

Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey

Racial and ethnic disparities have been documented for many physical health outcomes in children. Less is known, however, about disparities in behavioral and learning disorders in children. This study uses data from a national health survey to examine racial and ethnic differences in identified attention deficit hyperactivity disorder (ADHD) and learning disability (LD). The 1997-2001 National Health Interview Surveys obtained information from parents about the health and sociodemographic characteristics of children. Using these data, prevalence rates of identified ADHD and/or LD were estimated for Hispanic, African American, and white children 6-11 years of age. Racial and ethnic differences in health conditions, income, and insurance coverage were examined as possible explanations for disparities in parental reports of ADHD and LD, as well as the use of any prescription medication among children with ADHD. Hispanic and African American children, compared to white children, had parental reports of identified ADHD without LD less often, and adjustments for the confounding variables-birthweight, income, and insurance coverage-did not eliminate these differences. Hispanic and African American children, compared to white children, also had parental reports of ADHD with LD less often after adjustments for the effects of confounding variables. By contrast, after adjustments for confounding variables, Hispanic and African American children were as likely as white children to have LD without ADHD. Among children with ADHD, use of any prescription medication was reported less often for Hispanic and African American children than white children. These disparities in medication use persisted after adjustments for confounding variables. The prevalence of ADHD and the use of any prescription medication among children with ADHD differed among Hispanic, African American, and white children. These disparities could not be explained by racial and ethnic differences in other health conditions and sociodemographic variables.

How the Question Is Asked Makes a Difference in the Assessment of Depressive Symptoms in Older Persons

The authors examined whether older adults respond comparably to two standard depression instruments rating symptoms by frequency/duration or degree of severity/"bother." Data for this cross sectional analysis of a prospective cohort came from 699 community-dwelling individuals within the communities of Durham, North Carolina, and New Haven, Connecticut. Differences in response between the Center for Epidemiological Studies-Depression (CES-D) survey, emphasizing symptom frequency, were compared with the Hopkins Symptom Checklist (HSCL) subscale, emphasizing bother or discomfort related to those symptoms. Socioeconomic, demographic, and clinical characteristics for subjects with the greatest difference between standardized scale scores were analyzed with multivariable logistic regression. Older persons differed in their responses between the two instruments, despite similar content. Individuals in the highest quartile of difference between the two scales (indicating more bother than symptom frequency) had significantly more education, higher income, and were less often African American, with no differences in health conditions. Moreover, these specific socioeconomic and ethnic characteristics remained significant in multivariable analyses. Older persons not only differed significantly in their responses between depression instruments based on one dimension or the other, although with similar content, but response was significantly associated with specific subject characteristics. The heterogeneity of older patient populations suggests that recognition of depressive symptoms should include both constructs of symptom-associated discomfort and symptom frequency to achieve more accurate assessment.

Quality of health information on the Web: user perceptions of relevance and reliability

Relevance is the central concept in information retrieval yet studies of the quality of health Web sites have focused exclusively on the reliability of on-line health information. Results from the Web survey component of a multi-method study of Canadian women who seek health information on the Web reveal the importance of relevance as an attribute of quality assessment. Gender differences in health conditions and the geographical context of health information and delivery of health services are identified by study participants as dimensions of the contextual or situational relevance of health information. Survey respondents rated 13 types of health information sources in terms of their perceived relevance and reliability. Health care practitioners, books and pamphlets/fact sheets received high ratings on both attributes of source quality. Web sites received favourable ratings on relevance but intermediate on reliability.

What does ‘gender and health’ mean?

‘Gender and health’ is a contested concept whose various meanings have evolved in the course of the emergence and development of social movements concerned with the health of men and women. At the heart of the meaning of ‘gender and health’ advanced by the women’s health movement is the idea of a relationship of social and political inequality between men and women in the field of medically dominated health services. Population health discourse, embraced by the ‘new managerialism’ in public health policy and the ‘new public health’, proposes a concept of ‘gender and health’ that is based on sex differences in health conditions. This is also evoked in men’s health discourse so that ‘gender and health’ refers to the measurable margins of difference in the health conditions of mutually exclusive populations—men and women. Inequality is a feature of this representation but it relates to sex differences in health rates. Health outcomes or needs are thus ‘gendered’ to the extent that the magnitudes of the rates in sex-based health conditions are unequal. Given the conceptual and evidentiary incoherencies in population health and men’s health discourses, the meanings they ascribe to ‘gender and health’ would seem to have limited analytical power and relevance for public health policy.

Health Care in Rural Texas

The purpose of this article is to assess the quality of health and health care services available to rural Texans. Specifically, we seek to answer two related questions. First, do people living in rural areas of Texas generally suffer from poorer health than people living in urban Texas? One undoubtedly would think so, given frequent references to the low quality of personal services in general for rural America. Moreover, the persistence of the congressional Rural Health Care Caucus over the past two decades points to a rural health care crisis. Second, to what extent are these differences in health conditions explained by differences in access to health care enjoyed by people living in the two different regions? Access certainly appears to be the problem alluded to above. Rural people apparently lack physician care. In addition to providing answers to these questions, we also examine the difference in the health conditions and access to care enjoyed by minority and non‐minority rural Texans. Is this a part of the rural health care problem given the high incidence of non‐whites in rural Texas? If so this may be minority rather than rural neglect. We briefly conclude the article with some recommendations for improving the problems we identify.

Equity and gender

Gwatkin's paper provides an excellent historical review of the developments in thinking and research with regard to health inequalities and the health of the poor. More importantly, the paper provides a thought-provoking analysis of the impact of those developments on policy and its implications for health inequalities and the health of the poor. I agree entirely with Gwatkin's conclusion that there has been a puzzling disconnection between policy discourse and the setting of health policy objectives and that this disconnection has severely limited the impact of health policies and programmes in reducing health inequalities or solving the health problems of the poor. The central thesis of Gwatkin's paper is that health goals based on societal averages without an effort to incorporate distributional differences in health conditions across the socioeconomic classes do very little to meet the needs of the poor. I would like to add that the setting of health targets based on societal averages also masks gender differentials and thereby fails to deal with the gender-based health inequities that take a great toll on the health of women. In India, for example, using under-five-year-old mortality rates in aggregate form as an indicator of health status would mask the fact that the deaths of girls in this age group exceed those of boys by nearly 330 000 annually (1). Although Gwatkin acknowledges gender inequalities in health status when discussing the dimensions of inequality that matter most, he restricts his recommendation for disaggregated goals to the socioeconomic dimension. It could be argued that because women constitute about 70% of the world's poorest people, disaggregation by socioeconomic status and the pursuit of health goals that specifically target the poor would automatically include the needs of women. But just as Gwatkin argues that using a pro-poor target, such as reducing under-five-year-old mortality by one-third, may not result in any appreciable improvements in the conditions of the poorest, it could be argued that a target to improve the health status of the poor without explicit goals to improve women's health may likewise run the risk of completely missing the health needs of the most vulnerable and the poorest of the poor -- women. Poor women suffer the interactive consequences of two of society's most persistent and damaging inequities, poverty and gender. If the goal of health policy is to reduce health inequalities, it is imperative to set explicit goals for improvements in women's health. Meeting gender-based health goals, however, will only be possible with an approach that addresses the gender-specific sociocultural and economic factors that increase women's vulnerability to illness and infection and restrict their access to health care information and services. For example, women's use of health services has been found to be impeded by sociocultural norms that restrict their mobility or limit their participation in household decision-making (2). Research on human immunodeficiency virus/acquired immunodeficiency syndrome has also shown that economic dependence and income insecurity act as significant constraints for women who want to adopt preventive practices such as the use of a condom, if these go against the wishes of their male partners (3). …

Differential fertility in rural Nepal

Abstract Fertility differentials between geographical areas (Hills and Terai) and landholding and education groups within the areas were analysed from the first longitudinal sample surveys conducted in Nepal. Results indicated that fertility is higher in the Hills than in the Terai among older women who have been married for longer periods. The periodic return of Gurkha soldiers to the Hills, and differences in health conditions which may contribute to higher foetal wastage among Terai women, are suggested as a possible explanation for the difference. Within both Hill and Terai areas fertility was generally higher among those with larger than those with smaller landholding and in the Hills fertility was inversely related to education; however, in the Terai fertility varied directly with education. Differences in breastfeeding patterns between women who had received different amounts of education within the geographical areas may account for this latter finding.