High Proportion Of People Research Articles

MARITAL STATUS, NATION MARITAL STATUS COMPOSITION, AND SELF-ASSESSED HEALTH

ABSTRACT This study examines to what extent the often found association between marital status and self-assessed health is influenced by the marital composition of the country people live in. Four hypotheses explaining why the national marital status composition may be influential are derived and tested. Whereas earlier research in this field solely focused on divorce rates, this study includes six different indicators of the national marital status composition to provide a comprehensive test of our expectations. We employ data on 29 European countries (European Social Survey 2002, 2004, and 2006, N=97,797). Multilevel regression analyses demonstrate that both the strength of the relationship between marital status and health, and which unmarried group is most disadvantaged, vary across European countries. Living in a country with a high proportion of married people appears to be beneficial to the health of never married persons, but detrimental for widowed people. Additionally, our findings contradict the argument that divorced, widowed, and never married persons may be best off when living in countries with high proportions of people who are in the same situation. Finally, our results show that the never married are worst off in countries with a high proportion of cohabitants. This may reflect stronger health selectivity into cohabitation in countries where cohabitation is more common. We conclude that the ways through which the marital status composition influences the association between marital status and health appear to be complex and highly dependent on the exact marital status groups that are examined.

Multiple economic evaluations of Early Detection (ED) and Early Intervention (EI) for young people with first episode psychosis

Background/Objectives: Recent studies show good evidence on the relationship between the length of the prodromal period and the risk of developing psychosis; the longer the duration of untreated psychosis, the higher the risk. It is suggested that early identification of at risk states before manifestation of severe disease can be effective in preventing mental disorders and can much reduce the economic burden to individuals as well as our societies. However, economic evaluation in the early psychosis field is lacking. The project aims to help policymakers to choose both clinically effective and cost-effective preventative strategies across various sectors including the health care service sector as well as the criminal justice system, education and employment. We explore what lessons can be leant from the findings of our models in which we also adapted some EI approaches used in UK contexts to the Australian setting. Methods: Four decision-analytical models are built to compare community-based multidisciplinary teams for Early Detection (ED) and Early Intervention (EI) in first episode psychosis with standard care. Data on costs and benefits in terms of vocational, educational, criminal justice system, and suicide related outcomes are based on empirical studies, literature review and national expert opinions. Sensitivity analyses are conducted to examine the robustness of different assumptions in the models. Results: In our first model on ED, although the intervention cost for usual care is the least costly, it incurs the greatest health care and societal cost (A$ 33,018) because of a higher proportion of people ending up with a transition to psychosis. Relative to usual care, ED costs A$ 8,288 per one psychosis event prevented with CBT, A$ 16,605 via medication regimen, and A$ 13,512 through combined therapy. The second EI model on vocational outcomes results in EI costs which are 32% lower. The expected costs of lost employment are A$ 14,165 for EI, and A$ 20,728 for standard care per year. In a sensitivity analysis, when the average wage is used instead of minimum wage, there is an increased difference in the costs for the lost employment between EI and standard care (A$ 25,441 vs. A$ 37,325). In our third EI model on homicide, the yearly cost for homicide per patient after standard care is almost 10 times higher than that of EI (A$ 16 vs. A$ 162). The fourth EI model on suicide showed the expected yearly costs of suicide with EI, which is only one third of that with standard care (A$ 2,104 vs. A$ 6,479. Therefore, overall EI services have substantially lower costs than standard care. Discussion/Conclusions: These modelling exercises do offer flexibility in estimating costs and effects, which can be adapted to local circumstances. Similar to the considerable cost savings found in UK settings, EI services in the Australian context suggest significant savings due to reduced lost employment at work, as well as decreased homicide and suicide events.

The spatial distribution of esophageal and gastric cancer in Caspian region of Iran: An ecological analysis of diet and socio-economic influences

Recent studies have suggested a systematic geographic pattern of esophageal cancer (EC) and gastric cancer (GC) incidence in the Caspian region of Iran. The aims of this study were to investigate the association between these cancers and the region's dietary and socioeconomic risk factors and to map EC and GC after adjustment for the risk factors and the removal of random and geographic variations from area specific age standardised incidence ratios (SIRs).We obtained cancer data from the Babol cancer registry from 2001 to 2005, socioeconomic indices from the Statistical Centre of Iran, and dietary patterns from the control group in a case control study conducted in the study region. Regression models were fitted to identify significant covariates, and clusters of elevated rates were identified.We found evidence of systematic clustering for EC and GC in men and women and both sexes combined. EC and GC SIRs were lower in urban areas, and were also lower in areas of high income. EC SIRs were lower in areas with higher proportions of people having unrestricted food choice and higher in areas with higher proportions of people with restricted food choice.EC and GC were associated with aggregated risk factors, including income, urbanisation, and dietary patterns. These variables represent the influence of improved lifestyle which has coincided with a decrease in upper gastrointestinal cancer frequency over recent decades but which has not necessarily been uniform throughout the region.

Comparisons of Body Image Perception, Health Related Lifestyle and Dietary Behavior Based on the Self-Rated Health of University Students in Seoul

This study was conducted to examine the differences in perceived body weight and image and various lifestyles based on the self-rated health of university students when gender was adjusted. Five hundred fifty-five participants were asked their perceived health condition, and 58, 289, 160 and 48 students answered themselves as very healthy, normal, and unhealthy, respectively. As compared to the other 3 groups, unhealthy group showed higher proportions in dissatisfaction of body weight and negative perception of body image (P < 0.01). As health related lifestyles, very group reported longer sleeping than unhealthy group (P < 0.05), and had a higher proportion of people with regular exercise. Among the dietary behaviors, the frequencies of followings significantly different among the groups: Regularity of meal time (P < 0.01), Eat protein more than twice a day (P < 0.001), Eat vegetables (P < 0.01), Eat fruit and fruit juice (P < 0.01), Eat vegetable oil added foods (P < 0.01), Eat seaweed (P < 0.01), Eat breakfast (P < 0.01), Modulation in animal fat and high in cholesterol intake (P < 0.01). Particularly, higher proportion of subjects answered very had higher frequencies (6-7 times/ week) of these dietary behaviors. Overall results suggest that healthy lifestyle including adequate sleeping time, regular exercise, and good dietary behaviors might be potential factors affecting positive perception of health. In addition, positive perception of body weight and image were related with positive perception of health. (Korean J Community Nutr 16(6) : 672~682, 2011)

Weather and migraine: Can so many patients be wrong?

A migraine trigger is a factor which temporarily increases the probability that a migraine headache will occur, and many individuals with migraine blame certain weather conditions for initiating at least some of their migraine attacks (1,2). Some consider weather changes to be their most important headache trigger and even go so far as to refer to themselves as ‘human barometers’. A large, recent, clinic-based study of patient perceptions has indicated that 53% of migraine patients perceive that weather triggers their headaches at least occasionally, and 11% felt that weather triggered at least two-thirds of their headache attacks (2). The perception that weather can trigger headaches is not limited to patients with migraine; a substantial proportion of patients with tension-type headache also report weather as a headache trigger (3,4). While it might be argued that patient self-report of headache triggers from surveys based on memory of past events might be unreliable, data based on patient diaries where patients recorded the factor they felt was responsible for their headaches on a daily basis have given similar results (5). A population-based diary study in France performed in this manner indicated that 35% of migraine sufferers felt that weather had triggered at least some of their attacks. Of interest, similar to a clinic-based study (3), it was found that weather was reported as a headache trigger by a higher proportion of migraine patients as compared to patients with other headache types (35% vs 18%; P< 0.05) (5). On the other hand, in another clinic-based survey study of relatively severely affected headache patients, 45.5% of migraine patients listed weather changes as a headache trigger, and this was not different from patients with tension-type headache (48%) (6). In patients drawn from the general population, Rasmussen (4) found, perhaps surprisingly, that a higher proportion of people with tension-type headache reported weather as a headache trigger than did individuals with migraine. Clearly, when it comes to weather, many patients including both those with migraine and those with tension-type headache consider it to be a factor in triggering their attacks. Yet a very sophisticated recent study by Zebenholzer et al. (7) was unable to show any major connection between weather conditions and migraine occurrence. Although some association was shown between wind speed and day-to-day change of daily sunshine duration and migraine occurrence, none of these associations remained statistically significant after correcting for multiple testing by means of a Bonferroni correction (only P-values of <0.0018 were considered significant). The conclusion of the authors was that: ‘The influence of weather factors on migraine and headache is small and questionable’. Some previous studies which tried to identify weather factors as migraine triggers have also been negative (8,9). Others have shown at least some associations between certain weather conditions and migraine occurrence (10–15), but no consistent picture of which weather-related factors are important migraine triggers has emerged. Can so many migraine patients be wrong? Or is there another reason why research to date has been unable to measure the apparently robust association between weather and migraine attacks that so many of our patients tell us exists? Is the problem with the patients or with the research? Pertinent to this discussion is that a number of studies have found little correlation between whether patients think they are weather sensitive, and whether they actually are based on research results. Although Prince et al. (10) found that 50.6% of patients in their study were weather sensitive, there was no significant difference in the degree of weather sensitivity found

Dental caries experience among young Australian adults

Dental caries experience among young Australian adults

The association between commuter cycling and sickness absence

ObjectiveTo study the association between commuter cycling and all-cause sickness absence, and the possible dose–response relationship between absenteeism and the distance, frequency and speed of commuter cycling. MethodCross-sectional data about cycling in 1236 Dutch employees were collected using a self-report questionnaire. Company absenteeism records were checked over a one-year period (May 2007–April 2008). Propensity scores were used to make groups comparable and to adjust for confounders. Zero-inflated Poisson models were used to assess differences in absenteeism between cyclists and non-cyclists. ResultsThe mean total duration of absenteeism over the study year was more than 1day shorter in cyclists than in non-cyclists. This can be explained by the higher proportion of people with no absenteeism in the cycling group. A dose–response relationship was observed between the speed and distance of cycling and absenteeism. Compared to people who cycle a short distance (≤5km) three times a week, people who cycle more often and longer distances are absent for fewer days on average. ConclusionCycling to work is associated with less sickness absence. The more often people cycle to work and the longer the distance travelled, the less they report sick.

Social determinants of prescribed and non-prescribed medicine use

BackgroundThe aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care.MethodsCross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out.ResultsMore women than men took medicines (75.8% vs. 60% respectively). The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%). In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%). A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines.ConclusionThis study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.

Genetic demographic study of shors in Tashtagolskii raion of Kemerovo oblast: Population dynamics and changes in the sex and age composition

The population dynamics and changes in the sex and age structure of the Shor populations of four rural district municipalities of Tashtagolskii raion of Kemerovo oblast (Kyzyl-Shorskii, Ust-Anzasskii, Ust-Kolzasskii, and Ust-Kabyrzinsskii) with time have been analyzed. The Shor populations have been found to have contained a high proportion of people under 18 years of age during two periods, 1940-1955 and 1970-1975 (38.12-46.38 and 40.98-54.97%, respectively). However, the population reproduction pattern changed into the "reduced" one in all the municipalities studied by the early 2000s. Although there are some regional variations, a common trend towards rural population aging has formed: the man age in the Tashtagolskii raion population has increased by 7.52 and 6.94 years for men and women, respectively, during two generations; the natural sex ratio has been disturbed in both the prereproductive and reproductive populations. The total population size and effective reproductive size have decreased in three out of the four rural subpopulations studied.

SERVICE CONTACT: CHANGES OVER FIVE YEARS IN A TOTAL POPULATION SAMPLE

The impact of a new community based service (NIMROD) on generic service contact was assessed for people living in different residential settings: supported accommodation in ordinary housing; mental handicap hospitals, and private family homes. 1 Results over five years indicated considerable variability in patterns of generic service usage and provided evidence of a limited impact of NIMROD on the frequency and type of services used. While receipt of NIMROD may have effected an increase in service usage for some people living in family homes, findings also indicated an opposite effect for those who moved into supported accommodation. Doctors and dentists were used by a consistently high proportion of people over time. The most marked change in service usage during the study was an increase in the use of chiropody services by hospital residents. The central role played by General Practitioners in community based care is discussed and the importance of examining client need in conjunction with extent of service usage is highlighted.

A1C for Screening and Diagnosis of Type 2 Diabetes in Routine Clinical Practice

OBJECTIVETo evaluate A1C for screening and diagnosis of undiagnosed type 2 diabetes defined by oral glucose tolerance testing in clinical and general populations.RESEARCH DESIGN AND METHODSA1C cut offs (≤5.5% to rule out diabetes; ≥7.0% to rule in diabetes) were derived from a clinical group (Melbourne Pathology [MP] group: n = 2,494; undiagnosed diabetes 34.6%) and then evaluated in a population-based sample (AusDiab group: n = 6,015; undiagnosed diabetes 4.6%).RESULTSFor diabetes in the MP and AusDiab groups, A1C at 5.5% gave sensitivities of 98.7 and 83.5%, while A1C at 7.0% gave specificities of 98.2 and 100%, respectively. Many (61.9–69.3%) with impaired A1C (5.6–6.9%) in both populations had abnormal glucose status.CONCLUSIONSA1C ≤5.5% and ≥7.0% predicts absence or presence of type 2 diabetes, respectively, while at A1C 6.5–6.9% diabetes is highly probable in clinical and population settings. A high proportion of people with impaired A1C have abnormal glucose status requiring follow-up.

Bridging the gap between claimed and actual behaviour

PurposeThe purpose of this paper is to understand better the number of people consuming alcohol, the types of beverages chosen and the amount of alcohol consumed.Design/methodology/approachActual alcohol consumption collected using the covert observation method is compared with claimed alcohol consumption collected through surveys to understand the extent of the gap between claimed and actual behaviour.FindingsA notable gap between claimed and actual drinking levels was evident. A total of 70 percent more males were observed drinking alcohol at risky or high‐risk levels while 49 percent more females were observed drinking at risky or high risk levels when compared to claimed behaviour data. Further, a higher proportion of people were observed drinking alcohol than claims lead one to believe.Research limitations/implicationsThis research used human covert observation, thus limiting episode length. Further, this study was restricted to six venues in one month of one year. Future research opportunities abound including the use of electronic devices, variation in the observation methodology employed, and extending covert observation to different venue types, locations, and times of year.Practical implicationsThe covert observation method can be used to critique the impact of the socially responsible programs and practices. Public policy makers may need to be mindful that alcohol may be consumed by more people in larger amounts than is currently reported in studies employing survey methodologies.Originality/valueThe paper demonstrates how the covert observation method can be used to record what consumers actually do. The covert observation method can be used to extend the understanding of alcohol consumption by enabling researchers to observe behaviour in naturalistic settings.

Uncorrected refractive error in the northern and eastern provinces of Sri Lanka

Background: The 2004 tsunami focused unprecedented international aid and resources on Sri Lanka. Among other responses, a program delivered by volunteer optometrists enabled many local people to access eye examinations and spectacles for the first time. The data collected from the eye‐care delivery program during 2005 are summarised in this report, as an evidence base for planning future eye‐care interventions in these provinces or similar areas.Methods: A total of 96 eye clinics were conducted by visiting volunteer optometrists in the northern and eastern provinces of Sri Lanka, at which 20,090 people were examined. Clinical records were reviewed for conditions causing visual impairment, conditions that could cause impaired vision in future if left untreated, eye‐care outcomes and barriers to seeking care.Results: Complete records were available for 14,669 people. Seventy‐nine per cent of this clinical population had never had an eye examination. Uncorrected refractive error including presbyopia caused visual impairment for 78 per cent (11,388) of people who presented for an eye examination. Cataract caused impaired vision for 15 per cent (2,180) of people and was the main reason for referral beyond primary eye‐care, although only five per cent (695) of people presenting were referred for cataract surgery, as local capacity constraints set a visual acuity requirement of 6/36 or worse. The gender and age profiles of people attending the clinics were not consistent with equitable blindness prevention.Conclusion: The high proportion of people who had not previously had an eye examination, particularly those with significant uncorrected refractive error, provides evidence for the acute need for further development and support of community‐level eye‐care services in the regions visited. Women and older people should be targeted by future programs to achieve equity of blindness prevention.

Acceptance of Transgenic Milk in La Araucania Region,Chile

A B S T R A C T Considering the high level of concern caused by genetically modified foods (GMF) in developed countries, the relevance of this variable in decision-making about the purchase of fluid milk among consumers in Temuco (La Araucania Region, Chile) was determined. By means of a personal survey of 400 people and using conjoint analysis, it was determined that the presence of genetic modifications in food was more important (44.7%) than brand (29.5%) and price (25.5%) in the decision-making process. By cluster analysis three segments were identified; the largest group (46.5%) gave similar relevance to food production and brand, preferring genetically modified milk. For the second group (41.5%), the presence or absence of genetic modification was the most important variable in the purchase, with a strong rejection of milk produced by genetic manipulation and preference for non-transgenic milk. The minority segment (12.0%) placed a higher value on price. These three segments prefer national brand milk, reject the product with private brands and react positively to lower prices. The most sensitive segment to genetic food manipulation had a higher proportion of people under 35 years of age and with no children. It is concluded that the absence of genetic manipulation in food is a desirable condition, mainly for young consumers of La Araucania Region.

A health profile of adults with multiple sclerosis living in the community

Objective To describe the frequency of impairments, disabilities, and related services used in a community sample of adults with multiple sclerosis (MS) to estimate the service needs of this population. Methods A community-based postal survey conducted using a self-completion questionnaire consisting of MSQOL-54 questionnaire, Nottingham Extended Activities of Daily Living (NEADL) and some demographic items as well as items to ask about MS-related symptoms and/or problems and using available services. Adults with a diagnosis of MS confirmed by a neurologist were recruited via primary care services in Southern Derbyshire, UK. Results Questionnaires were sent to 310 adults with MS and 201 completed questionnaires were returned – a response rate of 65%. The most commonly reported symptoms and/or problems were fatigue, sexual problems, urinary problems, and painful muscle spasms. Most respondents reported at least one contact with their general practitioner (GP) during the previous 12 months. However, contacts with other services potentially able to alleviate specific symptoms and/or problems were low. Conclusions The findings suggest under-use of existing health care services by those who experience potentially treatable symptoms and/or problems associated with MS. More needs to be done to raise awareness among people with MS and their carers about the services available to them. Given the very high proportion of people with MS known to make contact with primary care services, GPs have a vital role in providing this information.

The epidemiology of hepatitis C virus infection in Sweden

In Sweden, infection with hepatitis C virus (HCV) has been a notifiable disease since 1990, when diagnostic methods became available. Blood donor screening indicated that about 0.5% of the Swedish population (9 millions) had been HCV infected. Here we present the Swedish hepatitis C epidemic based on data from all the HCV notifications 1990-2006. During this time about 42,000 individuals (70% men) were diagnosed and reported as HCV infected. The majority (80%) were born in 1950 or later, with a high percentage (60%) born in the 1950s and 1960s. Younger people, 15-24 years old at notification, were reported on the same level each year. The main reported routes of HCV transmission were intravenous drug use in 65%, blood transfusions/products in 6%, and sexual in 2%, though unknown or not stated in 26%. Approximately 6,000 of all notified individuals have died during the study period. To conclude, the Swedish HCV epidemic is highly related to the increase of intravenous drug use in the late 1960s and 1970s, with a high proportion of people now chronically infected for more than 25 years, resulting in an increase of severe liver complications in form of cirrhosis and hepatocellular carcinoma. Furthermore the unchanged number of notifications of newly infected younger people indicates an ongoing HCV epidemic.

Psychotropic medication for behaviour problems in people with intellectual disability: a review of the current literature

A high proportion of people with intellectual disability have behaviour problems and psychotropic medication is a commonly used management strategy for these behaviours, despite lack of good-quality evidence to support this practice. In recent years, one randomized controlled trial among adults and four on children with intellectual disability have been published showing effectiveness of low-dose risperidone in the management of behaviour problems as compared with placebo. Most of these randomized controlled trials are of good quality and included a reasonable number of participants. Most of these studies showed adverse effects, however, somnolence and weight gain particularly being associated with risperidone treatment. Most of the evidence on other psychotropic medications such as antidepressants, mood stabilizers, antianxiety drugs and opioid antagonists is difficult to interpret because it is based primarily on small case studies. There is growing evidence in support of some antipsychotic medication, particularly the atypical antipsychotic, risperidone. Many of the studies of effectiveness included in this review have methodological flaws however. Therefore, the results need to be interpreted with caution. Furthermore, the paucity of evidence for some groups of medication does not necessarily mean that these medications are ineffective, but rather that their use is not currently supported by good-quality research.

Tattooing in prisons—Not such a pretty picture

Tattooing in prison represents a unique combination of risk factors for blood borne virus (BBV) transmission because it is illicitly performed by untrained operators with homemade, unsterile, and frequently-shared equipment. It occurs in a setting where a high proportion of people are already infected with hepatitis C virus (HCV) and other BBVs. This study measured the frequency of tattoo acquisition by prisoners inside and outside prison, and the associations between tattooing, injecting drug use, and HCV infection risk. A cross-sectional survey was conducted in correctional facilities in Victoria, Australia. Participants completed a questionnaire that asked about injecting drug use and tattooing and provided a finger-prick blood sample that was tested for HCV antibody. Six hundred and forty-two prisoners participated in the study; 449 had ever been tattooed, of whom 182 (41%) had been tattooed in adult or juvenile prison. Of the participants who were not tattooed professionally, 27% reported someone using the same needle, and 42% reported someone had used the ink before them. Prisoners with a history of drug injection were more likely to have a tattoo and to have acquired a tattoo in prison (OR 3.0; CI 1.7-5.4). The HCV antibody-positive prisoners were more likely to have acquired a tattoo in prison compared with HCV antibody-negative prisoners. Acquiring a tattoo in prison was common and the reports of sharing the tattooing needle and ink was high, placing prisoners at risk of acquiring HCV through tattooing in prison. Trials need to be undertaken that evaluate the risk and benefits of legal tattoos in prison.

Spricht das Angebot einer Patientenbeauftragten der Bundesregierung ältere Menschen an?

For the first time, this study investigates to which extent elderly persons write to the federal government commissioner for patient issues in Germany. A 33% sampling (n=850) of the written inquiries (correspondence and emails) addressed to the commissioner in the first six months of the year 2005 (n=2580) was investigated. Socio-demographic data were extracted from the material; furthermore, it was registered which diseases the citizens described. Older persons outweigh the younger (69% over 60 years, mean age 63 years). Within the group of the elderly, approximately as many persons belong to the age group 60-69 years and to the age group 70 years and older. Most frequently, the citizens describe chronic diseases of the musculoskeletal system. The new service of the federal government commissioner for patient issues appeals to the elderly in Germany. The high proportion of people with chronic illness among the inquirers emphasizes the need for information, advice and support for this target group. Further research is needed on the answers to the inquirers, and on the question how helpful the contact to the government commissioner's office is from the viewpoint of the citizens; furthermore, possible barrieres (e.g. social state) should be analyzed.

Digital divides: the implications for social inclusion

The information technology society surrounds us whether or not we choose to, or are able to, use it. We use the internet for shopping, communicating, recreation, entertainment and education (NTIA 2002). Research in the United States suggests that the vast majority of children now go online and that a high proportion of people believe internet access is useful for education (Lenhart et al 2001). Unfortunately, not all groups in society have equal access to the world wide web and there has been a great deal of research looking at what has been called the ‘digital divide’.