Differentials In Use Research Articles

Does ambivalence about becoming pregnant explain social class differentials in use of contraception?

Manual social class background has consistently been associated with markers of poorer sexual health. This study of adults examines contraceptive use across social classes and the role of ambiguity towards pregnancy in non-use. A nationally representative sample of Irish men and women aged 18-45 years were surveyed (n = 3317). Use of contraception in the last year and at the last occasion of vaginal sexual intercourse was queried. Reasons for non-use were examined. The consistency of contraceptive use in the last year was higher among women than men with lower use in unskilled manual social classes for both sexes. 'Not having planned for sex' was the most commonly cited reason for non-use (47% of men and 40% of women). 'Not caring if pregnancy occurred' was cited by 11% of women and 12% of men, while 'took a chance' was cited by 8% of both men and women. Results showed semi and unskilled manual women more likely to report that sex was unplanned or that they 'took a chance'. Among men, all other classes were more likely to report each of the ambivalence statements than the professional and managerial class. The study provides evidence of social class differentials in use of contraception among adults, and shows that these may be due, in part, to higher levels of ambivalence about pregnancy among working class women. The article adds to the socio-demographic literature on class differentials in unwanted pregnancy and extends research on adolescents to cover patterns for adult women and men.

Who Receives Healthcare? Age and Sex Differentials in Adult Use of Healthcare Services in Rural Bangladesh

Use of healthcare services may vary according to the cultural, social, economic and demographic situation of the person who may need care. In certain contexts, it particularly varies with age and sex of the potential user. Bangladesh is a less developed, primarily rural and predominantly Muslim traditional society with a pluralistic healthcare system. This paper endeavours to delineate the age, sex and other factors associated with obtaining healthcare in this pluralistic system. Using the Matlab Health and Socio-economic Survey, the paper uses logistic regression to ask whether factors commonly related to Western healthcare utilization in a theoretical framework useful in the study of Western research on healthcare services are also useful in the study of healthcare utilization in the developing world. Elderly women, never-married women and Hindus were less likely to visit any practitioner, which may indicate less health empowerment for these groups. Obtaining care is inversely related to household size and positively related to age (for men), education, poor health status and impaired mobility. Controlling for these factors, household wealth and ever-married status showed no significant effect on obtaining care. The differential in use of healthcare services can partially be ameliorated by changes in policy related to the elderly and women.

Toxicological detection of the new designer drug 1-(4-methoxyphenyl)piperazine and its metabolites in urine and differentiation from an intake of structurally related medicaments using gas chromatography–mass spectrometry

Studies are described on the toxicological analysis of the piperazine-derived designer drug 1-(4-methoxyphenyl)piperazine (MeOPP) in rat urine using gas chromatography–mass spectrometry (GC–MS). The authors’ systematic toxicological analysis (STA) procedure using full-scan GC–MS after acid hydrolysis, liquid–liquid extraction and microwave-assisted acetylation allowed the detection of MeOPP and its metabolites 1-(4-hydroxy phenyl)piperazine and 4-hydroxyaniline in rat urine after administration of a single dose corresponding to doses commonly taken by drug users. Therefore, this procedure should also be suitable for detection of a MeOPP intake in human urine. However, the metabolites of MeOPP are not unique and can be produced from other drugs. Therefore, differentiation of use of this designer drug from use of the medicaments dropropizine, oxypertine or others, which are metabolized to the MeOPP isomer 1-(2-methoxyphenyl)piperazine, is discussed.

Optimisation of NB-4 and HL-60 differentiation for use in opsonophagocytosis assays

Optimisation of NB-4 and HL-60 differentiation for use in opsonophagocytosis assays

Optimization of nb-4 and hl-60 differentiation for use in opsonophagocytosis assays.

Production of effective vaccine formulations is dependent on the availability of assays for the measurement of protective immune responses. The development and standardization of in vitro human cell-based assays for functional opsonophagocytic antibodies require critical evaluation and optimization of the preparation of cells for the assay. We report evaluation of a number of protocols with two continuous cell lines (NB-4 and HL-60) for the provision of differentiated cells for use in functional assays. Flow cytometric analysis of CD11b antigen expression, as a marker of differentiation, indicated that all-trans-retinoic acid (ATRA) gave improved differentiation (>80% of cells differentiated at 96 h) when compared with dimethylformamide (DMF) (<60% of cells differentiated at 96 h). Morphological changes during differentiation toward a neutrophil-like phenotype were assessed by scanning electron microscopy. HL-60 and NB-4 cells treated with ATRA showed more spreading and flattening than cells treated with DMF, further evidence that they may have achieved a more differentiated phenotype. The number of cell divisions in culture appeared to be critical because cell lines maintained in exponential growth for >40 passages failed to express CD11b antigen or show morphological changes associated with differentiation after exposure to either differentiation-inducing reagent. Late-passage cells also demonstrated increased tolerance to DMF. Our results indicated that ATRA supplemented with vitamin D(3) and granulocyte colony-stimulating factor affords robust, rapid, and reproducible differentiation of both cell types.

Water usage patterns in low-income urban communities in Uganda: Implications for water supply surveillance

The selection of water sources by poor households in three urban areas in Uganda is shown to be complex, with a range of communal water sources used. In all towns, significant numbers of households used multiple sources. An aggregated estimate of the level of use in the largest town, Kampala, showed little difference in the number of households collecting water from piped and non-piped sources. In the other towns, households in Soroti were more likely to use point sources than piped water and in Masaka most households used piped water, with unprotected sources the most common subsidiary source. Differentiation in use by source type was evaluated. In two of the towns no differentiation in use is seen. In Soroti, some differentiation in use is seen as the water from boreholes is widely used for drinking and that from other sources less frequently consumed. Supplemental water purchased from vendors was relatively uncommon in the towns, but two towns showed that many households collect rainwater for domestic use. The implications of these findings for the drinking water surveillance programme are discussed.

The Role of Materials Research in Ceramics and Archaeology

▪ Abstract Materials research has been applied successfully to the study of archaeological ceramics for the last fifty years. To learn about our history and the human condition is not just to analyze and preserve the objects but also to investigate and understand the knowledge and skills used to produce and use them. Many researchers have probed the limits and methods of such studies, always mindful that a glimpse at ancient reality lies in the details of time and place, context of finds, and experimentally produced data, usually compared with standards that were collected in an equivalent ethnographic setting or that were fabricated in a laboratory in order to elucidate the critical questions in a technology that could be understood in no other way. The basis of most studies of ancient technology has been established as microstructure; composition and firing; methods and sequence of manufacture; differentiation of use; use-wear and post-depositional processes; technological variability that can be interpreted as a pattern of stasis or innovation, which can be related to cultural continuity or change; and interpretation that can involve technology, subsistence trade, organization, and symbolic group- and self-definition.

Patterns of use of the female condom after one year of mass marketing.

The female condom is an effective new contraceptive method that can reduce HIV transmission. This study examines use of the female condom after 1 year of its mass marketing and compares this with use of the male condom. It is based on exit interviews conducted among a random sample of male and female customers visiting outlets that sell the female condom. Compared with reported use of the male condom, which was five to eight times as high in nonmarital as in marital partnerships, reported use of the female condom varied less by partnership type (it was twice as high in nonmarital compared with marital partnerships). In marital and regular partnerships, use of the female and the male condom increased with socioeconomic status (SES). In casual partnerships, use of the male condom increased with SES, but use of the female condom was higher for those with lower SES. Men reported higher levels of male condom use than women, but there were no gender differences in use of the female condom. These findings suggest that the largest contribution to HIV protection through use of the female condom may be within marital partnerships and among low SES men and women who engage in casual sex. The absence of gender differentials in use of the female condom suggests that women are able to exert greater control over the use of the female condom than they are over the use of the male condom. However, the overall low levels of female condom use among relatively affluent persons at outlets that sell the female condom indicate that the introduction of the female condom will be resource intensive.

Factors affecting use of contraception in Matlab, Bangladesh.

This study examines the relationship between family planning, perceived availability of contraceptives, and sociodemographic factors in rural Bangladesh. Data are from the 1990 KAP survey in the Matlab treatment and comparison areas, using a sample of about 8500 married women of reproductive age. The contraceptive prevalence rate was 57% in the treatment area but substantially lower in the comparison area where mainly traditional methods of family planning were used by women who did not know of a source of supply of contraceptives. Education has no effect on contraceptive use in the treatment area but in the comparison area, modest but consistent differentials in use by level of education were found. Number of living children is the best predictor for contraceptive use, followed by number of living sons, and the attitude of respondents and their husbands towards family planning.

Prevalence and frequency of health service use: associations with occupational prestige and educational attainment

The accessibility of health care services has been suggested to be one factor with the potential to ameliorate the health effects of socioeconomic disadvantage. From a randomly selected sample of households in the Lower Hunter Valley region, 2623 adults were surveyed in 1987-88 to identify their reported use of medical, allied and alternative health services during the previous four weeks. There was a higher prevalence of use of the 'usual' general practitioner and medical services among educationally disadvantaged respondents only. No significant differences were evident between educational or between occupational groups in the prevalence of use of either alternative services or health services generally. Fewer occupationally disadvantaged respondents reported using allied health services. There was no difference in the number of health services used. Disadvantaged respondents were more likely to use medical services exclusively. Only educationally disadvantaged service users reported using any health, medical or general practitioner services more frequently than expected. In contrast, only occupationally disadvantaged service users reported using allied health services (and allied health services other than dentists) more frequently. The lack of consistent differentials in use across health services in favour of disadvantaged respondents suggests that a number of health care services may not be responding to the greater need for health care among disadvantaged members of the community.

Fibroblast‐mediated differentiation in human breast carcinoma cells (MCF‐7) grown as nodules IN VITRO

The growth of cells in 3-dimensional form as nodules in vitro facilitates studies of in vivo cellular interactions. Taking advantage of this technique, human breast carcinoma cells (MCF-7) were co-cultured with stromal fibroblasts isolated from either normal or tumorous breast tissue to study the influence of such fibroblasts on tumor-cell growth and differentiation. Ten days after co-culture of carcinoma cells with fibroblasts from normal tissue at a 1:10 ratio, the size of nodules began to increase and stabilize by day 30 while the fibroblast number decreased and finally disappeared. Concurrently, the carcinoma cells underwent a progressive redifferentiation process which histologically resulted in the appearance of highly developed papillar and tubular structures after 2 months in culture. The production of mucins was further evidence that these cells had undergone differentiation. By contrast, when MCF-7 cells were grown alone or with fibroblasts isolated from a breast carcinoma, the nodules continued to exhibit their characteristic histodedifferentiation properties and did not grow. The re-establishment of a normal epithelial state of differentiation in MCF-7 carcinoma nodules indicates that the phenotypic characteristics of tumor cells are reversible and are influenced or controlled by the stromal environment by which these tumor cells are surrounded or in contact with. Overall, our results open the possibility of exploiting the effects that connective tissue cells have on tumor-cell differentiation for use in prevention and treatment of cancer.

Numerical differentiation for use in integrating unified constitutive equations

AbstractThe NONSS method for numerically integrating time‐dependent constitutive equations requires evaluation of the partial derivatives of the constitutive equations. A numerical method for evaluating these partial derivatives has been developed, thus avoiding the cumbersome task of analytically re‐deriving the partial derivatives when improvements to the constitutive model are evaluated. This method is based upon the adaptive finite‐difference algorithm published by Stepleman and Winarsky. Modifications of their algorithm are described that allow its efficient use within an extended version of NONSS, called NONSS‐ND.Using the MATMOD constitutive equations, the capabilities of NONSS‐ND are demonstrated by comparing the results of a wide variety of deformation simulations with those of NONSS, for which the derivatives are computed from analytical solutions. The numerical differentiation within NONSS‐ND is shown to be sufficiently accurate for use in integrating time‐dependent constitutive equations, but results in a 30–100 per cent increase in computation time. Multi‐element structural calculations are therefore found to be uneconomical, but NONSS‐ND is well suited for testing alternative constitutive models owing to its accuracy and its general applicability to highly non‐linear systems of differential equations.

Externalizing Question-Answering Strategies of Good and Poor Comprehenders

THIRTY PAIRS of students (one sixth-grade tutor and one fourth-grade tutee in each pair) worked with an expository text and five questions following the text in the presence of an investigator. Under study were number of text lookbacks encouraged by tutors, differentiation of use of lookbacks for text-based versus reader-based questions, and appropriate text sampling. Good comprehender-poor comprehender tutor differences in strategic behavior encouragement were expected. Audiotape data and observational notation data were reduced for a series of analyses of variance; significant differences by reading proficiency level were found for all strategies under test. The tutoring methodology is discussed as a reasonable alternative to traditional (e.g., interview and error detection) methods, as a means of externalizing strategic repertoires of readers.

Indicators for planning of health services: assessing impacts of social and health care factors on population health

Community health planning requires identification of the level of access to care and factors which affect the differentials in use of health services. In formulating strategies or alternatives for planning, some assessment of the current level or patterns of health services must be made. It is this element of the planning process that is addressed in this paper. In this study sixty-five specifically designated areas (medical market areas) in the Province of Quebec, Canada were selected. The analysis was performed using data obtained from a large scale study of physicians' responses to the introduction of universal medical care insurance in Quebec. Our analysis offered an opportunity to observe the impact of Medicare on access to care for those thought to be underserved.

Contraceptive Availability Differentials in Use and Fertility

Examines the association between family planning availability and rates of contraceptive use and marital fertility for groups of women at differing socioeconomic levels. The study utilizes data on objective contraceptive availability collected in the community modules of the World Fertility Surveys of Bangladesh Korea and Mexico. Data on respondents perceived contraceptive availability also are analyzed for Korea and Mexico. The analysis confirms that somewhat higher rates of contraceptive use are associated with community availability of services. Women who report that contraceptive services are accessible have higher rates of use than other women. In general the presence versus the absence of contraceptive services is the important distinction; ease of accessibility of services appears to have limited effects on rates of contraceptive use. Despite the association of contraceptive availability with use recent fertility levels do not vary consistently among women at different levels of availability. This apparent anomaly may result from an insufficient lag time between the measures of contraceptive availability and marital fertility. (authors)

Explaining the Low Use of Health Services by the Poor: Costs, Attitudes, or Delivery Systems?

The poor, especially children, continue to receivefewer health services relative to need than the affluent. Explanations have traditionally focused on cost constraints or on cultural differences. This paper provides empirical evidence that such explanations do not fully account for income trends in preventive and symptomatic use. A third explanation, based on inadequacies in delivery systems used by the poor, is required. Factors representing each explanation are added sequentially to a multivariate model in order to shed light on their role in the income-use relationships. Particularly instructive are changes in estimates when types of delivery systems are added, since system differences have been ignored in much previous research. The importance of factors promoting use among the poorly. e.g., public assistance, is underestimated, while the role of individual characteristics, e.g., attitudes, is overestimated. Results suggest that neither financial access nor health education, without accompanying improvements in delivery systems, will eliminate income differentials in use.

Massage and Remedial Exercises in the Treatment of Children's Paralyses; Their Differentiation in Use

Massage and Remedial Exercises in the Treatment of Children's Paralyses; Their Differentiation in Use