Poor Social Conditions Research Articles

Chronic cough and wheeze in children: do they all have asthma?

In the experience of both authors, children referred for investigation of a chronic productive cough often do not fit conventional diagnostic categories. The aim of this study was to answer two questions: 1) do such diagnostic orphans exist? and, 2) if so, can they be classified in a clinically useful manner? Eighty one previously undiagnosed children referred with a history of more than 3 months productive or rattly cough were studied prospectively. Investigations consisted of a detailed history, physical examination, and an extensive set of clinical investigations. Sixty randomly selected asthmatic children served as demographic controls. Children fell into three groups: 23 had newly diagnosed conditions, such as cystic fibrosis, or were indistinguishable from asthma; 24 had a history of major medical interventions (cardiac surgery, chemotherapy, tracheo-oesophageal fistula repair); 34 had a history of significant early respiratory tract infections, usually combined with poor social conditions. The latter group differed significantly from asthmatic controls in a wide range of demographic and clinical comparisons. Native American children were overrepresented. The results of this study suggest that early respiratory insults (whether viral or medical) can induce self-perpetuating inflammation, manifesting as a chronic productive cough and intermittent wheeze. The associations between poverty and infant chest infections or early invasive medical treatment with subsequent chronic respiratory disease are clearly definable and probably justify diagnostic terms distinct from asthma, particularly for use in epidemiological studies.

Chronic alcoholism in a forensic material. 1. Social parameters in alcoholics.

An investigation was performed on material from deceased from the Copenhagen County, examined at the Institute of Forensic Medicine during the period 1985-1989. The basis and the reliability of the diagnosis of chronic alcoholism in a forensic post-mortem material is discussed. The frequency of alcoholics in the autopsy material varied between 25 per cent and 30 per cent annually. The frequency of women was significantly lower than that of men. The alcoholics were generally younger than controls, they were more often divorced, but cohabited with the same frequency as controls. Both the alcoholics and the controls belonged mainly to the lowest social classes. Alcoholics lived in flats and died in the living room more often than controls. Special attention is given to persons dying in bathtubs and on staircases. The interval between 'last seen alive' and 'found dead' was significantly longer in alcoholics, signifying loss of social network. Both alcoholics and controls generally lived under poor social conditions, more pronounced in the former.

Musculoskeletal Disorders: Work-related Risk Factors and Prevention.

Work-related musculoskeletal disorders cause chronic pain and functional impairment, impose heavy costs on society, and reduce productivity. In this position paper from the Scientific Committee for Musculoskeletal Disorders of the ICOH, the most important risk factors at work are described. Work-related musculoskeletal disorders have high incidences and prevalences among workers who are exposed to manual handling, repetitive and static work, vibrations, and poor psychological and social conditions. The application of ergonomic principles in the workplace is the best method for prevention. International organizations should develop standards, common classifications, and terminologies. Surveillance systems should be further developed nationally and in workplaces, and more effort should be directed to information dissemination, education, and training.

Morbidity of Newborn Infants (NB) after Nursery Discharge; relationship to Early Discharge. 1588

We hypothesized that early discharge (ED) contributes to significant morbidity of the NB. Charts of 500 infants (under age 15 days) admitted 7/93-6/95 were reviewed. Eighty-four percent were discharged early (ED≤ age 2 d); 49% had onset of symptoms (OS) at ≤4d of age. OS does not always concur with age at readmission. Poor social conditions were defined in 39%. Of infants aged 1-7d, 50% had hyperbilirubinemia (HB). Of infants aged 8-14d, 3% had HB; 56% had ruled out sepsis (ROS). GA <39 weeks was significantly more common in HB cases (51%) compared to non-jaundiced infants (17%),(p<0.0001). Of infants with HB, 78% were breast fed (BF) compared to 48% of non-jaundiced infants (p<0.0001). OS of HB was at age 2.4±1.2d.

Epidemiology and Treatment of Chronic Bronchitis and Its Exacerbations

Epidemiology and Treatment of Chronic Bronchitis and Its Exacerbations

The child group used as a reference system when analysing frequency of morbidity in day-care centres.

Morbidity frequency was analysed among children attending six day-care centres in a suburb of Stockholm, Sweden. Absence due to illness was calculated annually for each child and correlated with each child's own group. Thus a child was classified as "often sick" or "mainly healthy" in relation to the other children in the child's own group, constituting a reference system. In almost every group a "sick third" was found, whose absence due to illness was twice that of the rest of the group. Children from families of lower social standing, those with a relatively large number of siblings and those living in poor social conditions were found to be among those most often reported as sick. In such families, smoking was more commonplace. These parents more often lived in a rented apartment than in a single detached owner house. Multiple linear regression analysis revealed that young mothers and children with several siblings had the strongest correlation with absence due to illness of the proband child. Increasing maternal age revealed improvement vis-à-vis all socioeconomic parameters investigated, reflecting an improvement in standing correlated to less sick children.

Les brûlures palmaires de la main de l'enfant 81 observations

The authors reviewed 81 children between the ages of 5 months and 3 years suffering from palmar burns of hands from 1988 to 1992. Most burns were unilateral (53), superficial 2nd degree (48), due to contact (55), in boys (48) and only affecting the palm (69). The initial treatment consisted of directed healing followed by a split-skin graft in 8 cases. The initial scar was not retracted in 58 cases, retracted in 17 cases and hypertrophic in 8 cases. 79% of children had no sequelae at 12 months. At more than three years, 15% of children (12) had sequelae: 9 adhesions of the first commissure, 5 flexion deformities of long fingers, 3 clinodactylies, 1 syndactyly. All were operated by trident plasties, Colston flaps or full-thickness skin graft. A final functional assessment was performed. 90% of children had no sequelae. Four children still presented moderate functional discomfort (3 adhesions of the first commissure requiring reoperation, one case of decreased sensitivity). Palmar burns in children have a good prognosis. Factors of severity are: involvement of the 1st commissure, associated dorsal burn, deep 2nd degree, poor social conditions, delayed management.

Thwarting the Guatemalan Coup

Thwarting the Guatemalan Coup Francisco Villagrán de León (bio) When President Jorge Serrano suspended Guatemala's constitution, dissolved Congress, and dismissed the courts on 25 May 1993, he must have expected public frustration with Congress, the 30-year-old leftist insurgency, and the generally poor social conditions to translate into overwhelming popular support for his actions. In all likelihood, he was hoping to pull off a presidential autogolpe similar to the one that Alberto Fujimori had accomplished in Peru a year earlier. What Serrano experienced instead was, fortunately, something quite unexpected. After an initial 48 hours of shocked paralysis, the groups and institutions that make up Guatemalan civil society began to mobilize, disjointedly at first, but more and more efficiently as time went on. In less than two weeks, the coup was reversed. Through the efforts of its civil society, and with critical international support, Guatemala turned what threatened to be another setback for Latin American democracy into an impressive victory for democratic rule. A look at how this occurred provides insight into the depth of democratic commitment among the large sectors of civil society that [End Page 117] firmly refused any return to the authoritarian past. It also underlines the importance of the principle of constitutionality as a rallying point for different social sectors and as the political-philosophical beacon that lit the way to a peaceful and legitimate resolution of the crisis. Only President Serrano himself knows why he thought he could succeed in such a radical course of action. There had been earlier signs that he was tempted by the idea of dictatorial rule. He had complained bitterly about a hostile press and had threatened on more than one occasion to place curbs on freedom of speech. He had repeatedly attacked congressional gridlock and had criticized the business community and other sectors for their lack of support and understanding. In the months leading up to the coup, Serrano had increasingly isolated himself from contacts with those sectors, as well as from many of his personal friends and political allies. On the international front, Serrano and his representatives had maintained a distinctly low profile during the constitutional crises in Haiti and Peru, declining to join in denunciations and calls for strong collective action. In addition, Serrano was the only Latin American leader to offer public support to Venezuela's President Carlos Andrés Pérez during his agonizing fall from power. But if Serrano had been flirting with the idea of dictatorship for at least a year, why did he choose May 25 to make his dictatorial gamble? His party had made a solid showing in municipal elections earlier that month—although in the context of record-low voter turnout—and he may have felt a newfound confidence. At the time, he faced tough upcoming negotiations with Congress over a budget increase for the Supreme Court and a new energy tax bill—negotiations that would require even greater illegal payoffs than were already standard. During the previous week, there had been student demonstrations in which a demonstrator was shot and killed in front of Congress, apparently by a congressman's bodyguard. In addition, word had gotten out that charges of Serrano's own corruption—which apparently exceeded that of any of his predecessors—were going to be investigated by the auditor general's office. Finally, in mid-May Serrano had privately expressed frustration with Guatemala's stagnating peace talks, and had said he was looking for a way to back out of them. He may have seen the coup as a way to put the peace talks on the back burner, as well as to regain his standing with Guatemala's military. All these developments were symptoms of an overall crisis of governance, brought on by Serrano's autocratic leadership style and his inability to use negotiation and compromise to build consensus around his policies. During the past year, his administration had been drifting from crisis to crisis, wrangling with important groups ranging from human rights and labor organizations to the business community, professional groups (such as the bar association), and the media. Serrano [End Page 118] managed to avert the collapse of his administration only...

C-MOPP/ABV yields good results in a public hospital population with Hodgkin disease in Brazil.

Over the last 15 years, a number of combination chemotherapy regimens have been reported to induce more than 80% complete remissions (CR) in patients with advanced Hodgkin disease (HD). Almost all such studies have been conducted in large institutions from North America and Europe. It remains to be proven, however, that those regimens are equally effective for the larger population of patients with HD who live in very different social conditions in third-world countries. Fifty-nine patients with advanced-stage or early bulky HD were treated in two public hospitals with the C-MOPP/ABV hybrid program, in which cyclophosphamide was substituted for mechlorethamine. The median number of cycles administered was six, and the median follow-up was 32 months. Fifty patients (85%) reached a CR. The actuarial failure-free survival (FFS) rate was 69%, and the actuarial overall survival rate was 78% at 68 months. The only significant prognostic factor that predicted for improved FFS rate was the absence of B symptoms (P = 0.02). Overall survival was better for patients who reached a CR (P = 0.0003) and those with no systemic symptoms (P = 0.007). Toxic effects were moderate, with one treatment-related death and six episodes of serious infection. The target population consisted of lower-class Brazilians, many living in poor social conditions. Nevertheless, these results compare equitably with other results reported in the literature. C-MOPP/ABV is an adequate treatment for HD in third-world populations.

HELICOBACTER PYLORI IN THE PEDIATRIC PATIENT

H. pylori is the major cause of gastritis in children and adults. Studies in children have demonstrated a specific association between H. pylori and primary gastritis. H. pylori colonization of the gastric mucosa is also important in relation to the natural history of duodenal ulcer disease. Duodenal ulcers do not appear to relapse if H. pylori is cleared from the gastric mucosa. Because of the low incidence of duodenal ulcer disease in children, a multicenter study is required to demonstrate whether this finding is true in children. To date, no specific symptoms have been associated with the presence of H. pylori gastritis in children. H. pylori gastritis may therefore be an asymptomatic condition in the majority of infected children. Further studies in relation to H. pylori gastritis and symptoms in children will be important because it should be easier to identify specific symptoms in children than in adults. H. pylori gastritis in children can be diagnosed by obtaining antral biopsy specimens for culture and histologic study during upper gastrointestinal endoscopy. Serologic study is also a sensitive and specific indicator of H. pylori infection, provided that children's sera are used to standardize the assay. Noninvasive tests such as 13C urea breath tests are very attractive for use in children but are expensive. H. pylori can be cleared from the gastric mucosa in as many as 70% of children by using a combination of metronidazole or amoxicillin with colloidal bismuth subcitrate or bismuth subsalicylate. Studies in children are important in determining the epidemiology of H. pylori. Children in Western societies are not usually colonized. Infection becomes more common with increasing age. Children in underdeveloped countries and those living in poor social conditions in Western countries are much more likely to be infected at a young age. The reason for the increased prevalence of infection among these groups is not known. There is also significant intrafamilial clustering of H. pylori infection. Again, it is unclear why the organism is clustered within households and institutions. Future studies on children will be of importance in determining whether H. pylori gastritis is a cause of specific symptoms, the epidemiology of H. pylori infection, and the possible role of the organism in the natural history of gastric cancer.

Donovanose no Pará

From 1954 to 1990 granuloma inguinale was diagnosed in 259 patients al the dermatology service of the Universidade Federal do Pará in Belém, Brazil. Among them, 56 cases had occurred in the twenty-year period 1954-1974 and as many as 133 cases were seen during the last five years only. Greater sexual liberty, poor social and economic conditions, and especially increasing homosexual behavior were implicated by the authors as chief determinants for this augmented incidence of the disease.

An indicator of adverse pregnancy outcome in France: not receiving maternity benefits.

The aim was to compare the social characteristics, the pregnancy outcome, and the antenatal care of women in France who did not receive maternity benefits to women who did. These benefits (860 FF, approx 86 pounds per month) are given to every pregnant woman, starting in the second trimester. Payments are made on the condition that at least three antenatal visits are made, the first being before the end of the first trimester. The study involved a random sample of women who were interviewed after delivery during their stay in hospital. Data on pregnancy outcome were collected from medical records. The study was carried out in four public maternity units in different regions of France. 1692 women were included in the analysis (86.8% of the selected sample). Of 257 exclusions, 40 had multiple pregnancies, 189 had missing data, and 28 did not answer the question concerning maternity benefits. 4.3% of the women did not receive any maternity benefits. These women lived in poorer social conditions than the women who received the benefits. They had a higher preterm delivery rate, after controlling for risk factors in a logistic regression. Women without maternity benefits were characterised by a lower level of care, yet the majority began their antenatal care during the first trimester or had more than six visits. Not receiving maternity benefits during pregnancy is an index of an underprivileged situation and a risk factor for pregnancy outcome.

Epidemiological, social and psychiatric aspects in self-poisoned patients

A prospective study of an unselected group of patients admitted in a Medical Department in 1978 (n = 257) and 1987 (n = 361) after deliberate self-poisoning is presented. The rate increased significantly over the period of the study (P less than 0.05). Family problems, unemployment, poor social conditions and alcohol and drug abuse had increased. The main psychiatric diagnosis was neurosis. From 1978 to 1987 "abuse" had increased substantially. The 10-year mortality rate was 4.5 and 4.1 times the expected value for female and male patients, respectively. We conclude that social and psychiatric problems are increasing and that the treatment of these patients today is far from satisfactory.

Genito‐urinary tuberculosis: a review of 83 cases

We evaluated 83 cases of genito-urinary tuberculosis retrospectively. Flank pain and non-specific urinary complaints were the major symptoms. Although some authors prefer short-term medical therapy, the relapse rate in our series with six-month therapy was 22%, and we therefore suggest a therapy period of at least 12 months is necessary. The poor nutritional status and social conditions characteristic of subjects from our region may, however, be a factor in this high relapse rate.

Secular trend and age distribution of cribra orbitalia in Japanese

Cribra orbitalia is currently regarded as an indicator of environmental conditions. The prevalence and severity of this lesion in Japanese populations from prehistoric Jomon to modern times were recorded and discussed. Since the lesion was low in both frequency and grade in the late and final Jomon people from Chiba Prefecture, they presumably lived in relatively favorable environmental conditions. The increased prevalence of the lesion in the medieval Muromachi citizens of Kamakura may be attributed to the poor hygiene and social conditions. The high prevalence and marked severity of the lesion in the citizens of Edo (the old name of Tokyo) in the 17th century suggested that they lived under extremely unfavorable situations of nutrition, sanitation and medical care. Cribra orbitalia was most prevalent in adolescence (81.3%) among the Edo citizens. The incidence of the most severe type of lesion rose gradually during childhood, reached a peak in adolescence, and then gradually decreased with age. These findings would reflect intense marrow hyperplasia in the orbital roof associated with both iron deficiency anemia of long standing during the immature period and increased iron requirement in adolescence. The results obtained support the hypothesis that iron deficiency anemia is the primary factor in the etiology of cribra orbitalia. It was concluded that the incidence and severity of cribra orbitalia due to various anemic reactions reflected the dietary, hygienic, social and environmental circumstances of the populations investigated.

Speech rehabilitation in laryngectomees with tracheo-oesophageal fistulas and prostheses.

The Staffieri technique was used in 24 patients, but abandoned due to aspiration. The Blom-Singer or other prostheses were used in 40 cases, 50% achieved fluent speech, 15% spoke partially and 35% were not able to use the prostheses at all. Some complications are always met with in these cases: Dysphagia, leakage around the prostheses and difficulties with the function of the prostheses. The selection of suitable cases is important. Their cooperation and motivation must be ensured preoperatively, and in many cases like those living under poor social conditions or in older patients, this procedure should not be tried.

Infant Mortality in Europe: Implications for the United States. Statement to the National Commission to Prevent Infant Mortality

Infant mortality is not a health problem. Infant mortality is a social problem with health consequences. The first priority for lowering infant mortality in the United States is not more obstetricians or pediatricians or hospitals, nor even more prenatal clinics or well-baby clinics, but rather to provide more social and educational support to families with pregnant women and infants. This is the number one lesson to be gleaned from the experience of those industrialized countries in the world with the best record for lowering infant mortality. 70% of infant mortality occurs in the first month of life and is closely related to what happens during pregnancy and birth. Here the European experience does not support expanding medically-oriented prenatal care as a high priority in the US. On the other hand every European country, including the more developing ones, has an extensive system of social and financial benefits for families with pregnant women and infants and this should be given urgent priority in the United States. Caesarean section rates in the United States are double to triple those found in all European countries with infant mortality rates lower than the United States. At least one billion dollars are spent every year in the United States on these excessive surgical births with no benefit and with increased risk to both woman and baby. Every country in Europe with perinatal mortality and infant mortality rates lower than the United States uses midwives as the principal and only birth attendant for at least 70% of all births. The European experience shows that a strong independent midwifery profession is an important counterbalance to the obstetrical profession in preventing excessive interventions. The United States should spend far less money on interventionist obstetric care and put more resources into building up a large, strong midwifery profession. For the 30% of infant mortality between one month and 12 months of age, the excess deaths in the United States are related to poor social and economic conditions for these families. The principal solution for this type of infant mortality is not more medical care but, as exists in every European country, a system of social and financial benefits for families with infants. The United States is the only developed country in the world which is not putting an adequate basic minimum of resources into social and financial programs for families with pregnant women and infants. As a WHO staff member and as an American, I hope this Commission will have the vision and courage to start the process of rectifying this situation.

Labour insecurity and health: An epidemiological study in Zimbabwe

Existing data on health status and health care provision in agricultural labour communities in Zimbabwe indicate that both are poor. In addition, there is evidence that the concentration of capital through increased areas of landholdings, through mechanisation and use of agrochemicals produces a rise in under- and unemployment within the agricultural sector, which increases the risk of ill health. This paper addresses this question in Zimbabwe by examining the nature of developments within the large scale agricultural sector in the last decade, and the consequent effects on employment and income. Rising capital intensity in the private large scale sector is found to be associated with increases in unemployment and underemployment. The impact of this socioeconomic pattern on health is assessed in a longitudinal assessment of 78 permanent labour families and 76 non-permanent (underemployed) labour families in the large scale farming sector. The study shows that while poor social, economic and health conditions exist in all groups, non-permanent labour households suffer greater insecurity of employment and income, poorer health status and lesser participation in sociopolitical structures important for negotiating primary health care gains.

Developing Indian Academic Professionals

\Jf what use is a sociologist, anthropologist, political scientist, or historian to an Indian Tribe today? The Navajo Nation needs engineers, doctors, businessmen, and teachers desperately to achieve selfdetermination, and that is what we encourage you to prepare for. (From a speech by Chairman Peter MacDonald, Navajo Nation, November, 1978, University of New Mexico.) Chairman MacDonald's juxtaposition of technological, business and teacher training against scholarly formation for Indians gives rise to many questions which cannot be answered precisely, but which require close analysis. Given the alarming statistics reflecting the low educational level and commensurate poor social conditions of American Indians in the United States, such questions are not merely academic.

Characteristics of criminals: The privileged offender

In studying the etiology of crime, criminological theories rest, to a large extent, on studies based on registered offenders from the lower social classes. Their living conditions have inspired criminologists to develop so-called social deprivation theories to explain crime. According to these theories factors such as bad housing conditions, inadequate education systems, poor job opportunities, lack of recreational facilities favour the development of criminal behavior. Because of this frame of reference social deprivation theories usually are social class theories (Goppinger , 1980; Mannheim, 1965). Criminal behavior, however, is certainly not restricted to people with a low SES. As early as 1946 Porterfield was able to show that students too have quite a part in the total volume of crime. He found that compared to registered juvenile offenders the criminal “records” of students were even worse both quantitatively and qualitatively (Porterfield, 1946). It is obvious that criminal behavior of students cannot be explained by the poor social conditions under which many lower class offenders have grown up. Therefore focussing on this category of offenders might help us to increase our knowledge of the origins of crime.