Privileged Population Research Articles

Psycho-social determinants for psychiatric hospitalisation for neurotic disorders in women--a case-control study.

Much has been written about the determinants of psychiatric hospitalisation, chiefly for psychotic patients in an emergency. This paper reports the results of a comparative study between in-patients and pathological subjects from the general population. The aim of this work is to evidence the psycho-social determinants of hospitalisation in a psychiatric department for neurotic disorders. This study was conducted on a socially fairly privileged population which was, therefore, also fairly homogeneous. The subjects from the two groups were assessed clinically using standardised instruments both for diagnosis (SCAN) and for psycho-social variables (Stressful Life Events: LEDS; Social Support and Self-esteem: Pearlin checklist; care itinerary). Following the analysis of frequency and a multivariate logistic regression analysis, four risk factors for hospitalisation for neurotic disorders were evidenced, including: severity of neurotic disorders, taking a long time to consult a specialist after first onset of anxiety disorders, poor social support, and having experienced one or more provoking agents (Brown and Harris methodology) in the year previous to hospitalisation. The severity of the mental pathology is largely responsible for hospitalisation in neurotic patients as it is in psychotic patients, but it is not the only determinant for hospitalisation.

Fetal size to final height in Hong Kong Chinese children.

It has been known that size at birth is important for postnatal growth and final height. However, there are few data in the literature on the difference in height growth patterns from fetal size to final height between less privileged and more privileged populations. The aim of this study was to describe the important features in height growth from birth to maturity in an underprivileged Hong Kong Chinese cohort in comparison to a more privileged Swedish cohort. The longitudinal height growth data from birth to maturity in full-term healthy Hong Kong Chinese children (n=132) who were born in 1967 were analyzed, and compared with those for Swedish children who were born in 1973-75 (n=3650). Children with longer birth length achieved taller adult stature with respect to their target height. The mean final height retained the same order as that of the mean length at birth for various birth length groups. All children in the Hong Kong Chinese series showed catch-down height growth during the first 2 years of life, in contrast to the catch-up in smaller babies and catch-down in larger babies for the Swedish series. The growth deficit for the Hong Kong Chinese was -0.9 SDS at birth, -1.8 SDS at 2.0 years of age, -2.1 SDS at 8 years of age, and -1.7 SDS at final height. Fetal size is important for postnatal growth and attained final height with respect to a child's familial genetic potential in stature, not only for privileged populations, but also for underprivileged populations. However, children in underprivileged populations experience a persistent increasing growth deficit during infancy and childhood. Special attention should be given to monitor their growth status in early years and to institute appropriate intervention programs.

Cadaver profile at university of Stellenbosch Medical School, South Africa, 1956-1996.

Data on 1,698 cadavers donated during the period 1956-1996 were obtained from files of the Department of Anatomy and Histology at the University of Stellenbosch Medical School, Tygerberg Hospital, South Africa, to project a profile of the characteristics of those accepted on the program for dissection. A breakdown of the data also provided information on the profile of donors belonging to different population groups. Donors to our program were predominantly male (68%) and predominantly colored, which in South Africa identifies those of mixed heritage (63%). The average age of death was 55 years (range 15-98). Donors belonging to the white population group had the highest female : male ratio. Circulatory disorders accounted for most deaths in the white population group (48%), whereas cancer was the leading cause of death in the colored and black population groups ( approximately 25%). Pulmonary tuberculosis accounted for 13% deaths in the colored population group, 14% of deaths in the black population group, but only 0.5% of deaths in the white population group. Cervical cancer and breast cancer accounted for approximately one-third of cancer deaths in women, with cervical cancer more common in colored and black female donors and breast cancer more common in white female donors. The cadaver profile in general reflects the health status of the different population groups in South Africa. The profiles of the colored and black groups reflect that of disadvantaged population groups (a high prevalence of infectious disease; relatively young populations), whereas the white donor profile is that of a privileged population group (a high prevalence of degenerative disease; aging population).

Equity in Spanish higher education

The most outstanding event in the recent evolution of higher education in developed countries has been the continuously increasing proportion of students entering higher education and, therefore, its extension to more and more inclusive groups. It seems reasonable to assume that the expansion of higher education must have facilitated access of less privileged social classes, but it is important to analyze to what extent this significant increase in higher education participation has reached all social, economic, and cultural groups. This analysis could be useful in designing a policy to help those students who have more difficulty accessing higher education. The goal in this paper is to analyze this subject thoroughly focusing especially on the level of participation of young adults in Spanish higher education controlling for economic level, parental education and occupation, and other environmental characteristics. We present a logistic model which jointly values the influence of different family and social characteristics of the individual on his/her decision to enroll in higher education. The main conclusions of the study are these: (a) There has been improvement in the equity of access to higher education. In spite of this overall improvement, about 30 per cent of the less privileged population is still underrepresented in higher education, (b) Family educational level is the most important factor in the decision to enter higher education. The weight of these educational characteristics exceeds by far the influence of family income level.

Environmental safety preparation for community-based nursing educational experiences: measurable indices.

Cities, formerly the hub of cultural activities and entertainment, are now more often associated with crime statistics and poverty. Students' emotional comfort and safety must therefore be prime considerations in planning community-based nursing education. This study piloted an instrument that promises to be useful in labeling situations that affect an individual's comfort level in an urban setting. Questions that guided the study included: (1) Does the Environmental Comfort Scale (ECS) score vary with the respondents' residential zone (urban = 1, suburban = 2, rural = 3)? (2) Is the instrument (Environmental Comfort [Fear] Scale) reliable? A one-shot, one-group, pre-experimental design was employed. Participants were self-selected from a junior baccalaureate nursing class (N = 79) that was a predominantly suburban-bred, relatively privileged population. The ECS contained nine specific environmental-situation items that could be construed as potentially threatening to safety. Respondents were to indicate on a five-point Likert scale the extent to which they would be fearful in each situation; 1 = least fearful and 5 = most fearful. Findings showed practically no difference in responses by residential zone and suggest a need for item refinement and a need to lengthen the tool to improve alpha coefficients. Further, the increasing demand for measurable outcomes underscores the need for continued work on instruments to produce such data. The deinstitutionalization of health care from contained grounds to uncontained community-based settings makes it imperative that nursing education attend to the challenges of safety education.

Status Anxiety and Demographic Contraction of Privileged Populations

In a world numerically dominated by countries whose demographic problems involve fertility that greatly exceeds replacement, theoretical treatments of the opposite condition have not attracted the attention they deserve.' Social scientists find it easy to document the specific demographic mechanisms that by the 1980s have led to below-replacement fertility in nearly all developed countries. But while it is generally agreed that involuntary sterility or subfecundity is not a major cause of the phenomenon, no consensus has emerged regarding the social and economic forces that account for voluntary below-replacement reproduction.2 Moreover, many social scientists seem to assume that below-replacement fertility is unique to the modem era-an epiphenomenon produced by the unprecedentedly urbanized, industrialized, literate, and socially liberated character of twentieth century populations living in highly intrusive welfare states. 3 This article questions this ahistorical orientation to conceptualization and theory by arguing that the impending demographic contraction of most European populations is simply the latest illustration, this time on a mass scale, of the fact that privileged populations whose member families are committed to the preservation of their relative status have a chronic tendency toward demographic contraction. The evidence for this claim rests on a reanalysis of the data long available for some of Europe's most privileged subpopulations over the past four centuries, all of which tended to resist the recruitment of newcomers and to decrease in size over the long run.4 In the case of traditional European privileged populations, their slow demographic decay in the sixteenth and seventeenth centuries took place even though patterns of fecundity and survival to adulthood gave them the potential for rapid population growth. But this potential was never realized because of

The Natural History of Rheumatic Fever and Rheumatic Heart Disease in the Orient

Studies published in the past 10 years suggest that group A streptococcal infections are frequent in the Orient and lead to a high incidence of rheumatic fever (RF) and rheumatic heart disease (RHD). In the present study, streptococcal infections were found to be more prevalent in Japan and Taiwan, whereas RF and RHD were more common and severe in the Philippines, Thailand, and Indonesia, particularly among the socioeconomically less privileged populations. The pattern of childhood RF varied: Carditis was the most common manifestation, occurring in 57% to 94% of the patients; polyarthritis was generally atypical and less common in the tropics; chorea minor and erythema marginatum were much more common in Japan, less common in Taiwan and rare in the tropics. RF recurrences were quite common and led to the development of new carditis, and deterioration or persistence of the pre-existing heart disease. The 5 year mortality rates differed greatly, ranging from zero to 42%. There was disappearance of the heart murmur in 16.5% to 37.5% of patients. Such apparent recovery was related to adherence to chemoprophylaxis. The major risk factors adversely affecting survival were the severity of carditis, inadequacy of medical service, non-compliance to chemoprophylaxis, RF recurrence, poor socioeconomic status, and high prevalence of group A streptococci. It is concluded that there is no uniform "Oriental-type" of natural history of RF and RHD. The natural history varies greatly among countries as is true in other parts of the world.

Effects of prenatal nutrition upon pregnancy risk.

A large percentage of babies born under 2500 gm are not truly premat ure especially in less privileged population. Their prognosis is different and they must be managed differently. Careful study of this phenomena of poor growth in utero shows 2 patterns of cell growth: hyperplasia is increase in cell number while hypertrophy is increase in cell size. These phases are determined by relative DNA content in the cell. Malnutrition during hyperplastic growth will retard the rate of cell division and result in an organ reduced in size and containing a reduced number of cells. This change is not reversible after the period when cell division normally stops. Malnutrition during hypertrophic gro wth prevents the increase in cell size and again results in a smaller organ but this change is reversible at any time. The cells simply fill back up with protein and the individual cells and the entire organ achieve normal size. Work on understanding the growth process is just beginning but it is apparent that homeostasis is maintained in the cell as long as sufficient amino acids and nucleotides are supplied and the synthesizing process functions. Malnutrition upsets this delicate balance at several points. It limits availability of amino acids for protein synthesis redirects nucleotides away from DNA to RNA synthesis (retarding the activity of certain enzymes and increasing the activity of others) thus giving an increased rate of degradation out of proportion to the increased rate of synthesis. This decreases protein synthesis except for certain proteins such as RNA polymerase and alkaline RNase whose synthesis is often increased. 2 types of in utero growth failure seem to occur. In placental vascular insufficiency the flow of nutrients is restricted. Animals so affected show marked reduction in liver size and cell number but only transient brain changes. In maternal protein restriction all organs are affected including the brain. If the malnutrition continues after birth brain size reduction is more than the sum of prenatal malnutrition alone added to postnatal nutrition alone. Studies of infants who died at birth or in the 1st year of life show similar types of growth failure. So far elevated RNA polymerase activity seems the most promising measure of poor fetal growth but alkaline RNase and DNA polymerase activity are under investigation.

CAUSE AND CONTROL OF FATAL, INFANTILE DIARRHEAL DISEASES.

The United Nations Conference on the Application of Science and Technology for the Benefit of the Less Developed Areas is concerned with the practical means by which “science and technology can best serve the needs of the less developed countries.” The problem of fatal, infantile diarrheal diseases is being considered in this connection, because they are a major or principal cause of death in infancy and early childhood among the economically underprivileged populations of the world. According to Hardy and Schliessmann, consultants of the World Health Organization, the acute diarrheal diseases are estimated to account for about 5 million deaths of infants and children each year throughout the world. Among the economically more privileged populations, these diseases disappeared as an important cause of death only after the achievement of high living standards, which include improved nutrition, better housing supplied with safe, abundant water, sanitary disposal of excreta and facilities for proper refrigeration and storage of food, sanitary control of processing, storage and distribution of milk and other food products, control of feces-transmitting insects, increased availability of good medical care, and last but not least a markedly increased level of education.