Socioeconomic Background Factors Research Articles

Smoking and health-related quality of life in English general population: implications for economic evaluations.

BackgroundLittle is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions.MethodsUsing the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models.ResultsThe observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations.ConclusionSmoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status.

Does recalled dieting increase the risk of non-vertebral osteoporotic fractures? The Tromsø Study

The risk of non-vertebral osteoporotic fractures increased by increasing recalled amount of weight loss when dieting in women aged ≥ 46 years and in those with BMI < 25 kg/m(2) participating in the Tromsø Study (1994/1995-2009). The increased risk was present both in women with few and several episodes of recalled dieting. The influence of repeated dieting on bone health is uncertain. This study aims to investigate whether recalled dieting is a risk factor for non-vertebral osteoporotic fractures. In 1994/1995 weight and height were measured in all participants aged 25-69 years in the population-based Tromsø Study. Information about socioeconomic background, diseases and lifestyle factors was collected by questionnaires-including number of recalled dieting episodes and largest amount of weight loss when dieting. The participating 20,745 women and men were followed for 15 years, fractures were registered from X-ray archives and analysed by Cox's proportional hazards models. Among those who recalled dieting, 975 women and 364 men suffered a non-vertebral osteoporotic fracture during follow-up. Compared to women without recalled weight loss when dieting, women who reported their largest weight loss of 11 kg or more had a hazard ratio (HR) = 1.48 (95% CI 1.13-1.94) for osteoporotic fracture, adjusted for age, marital status, body mass index, height, education, physical activity, smoking, alcohol intake, history of cardiovascular disease and psychological distress. The increased risk was statistically significant only in women aged ≥ 46 years and in those with BMI < 25 kg/m(2). Women who recalled ≥ 11 dieting episodes had HR = 1.73 (CI 1.11-2.68) for osteoporotic fracture compared to those with no recalled episodes. Dieting was not associated with risk of fractures in men, but the number of fractures was low. The increased risk of non-vertebral osteoporotic fractures by recalled dieting in women indicates that maintenance of a stable weight may have beneficial effects on fracture risk.

Ecological analysis of social risk factors for Rotavirus infections in Berlin, Germany, 2007–2009

BackgroundSocioeconomic factors are increasingly recognised as related to health inequalities in Germany and are also identified as important contributing factors for an increased risk of acquiring infections. The aim of the present study was to describe in an ecological analysis the impact of different social factors on the risk of acquiring infectious diseases in an urban setting. The specific outcome of interest was the distribution of Rotavirus infections, which are a leading cause of acute gastroenteritis among infants and also a burden in the elderly in Germany. The results may help to generate more specific hypothesis for infectious disease transmission.MethodsWe analysed the spatial distribution of hospitalized patients with Rotavirus infections in Berlin, Germany. The association between the small area incidence and different socio-demographic and economic variables was investigated in order to identify spatial relations and risk factors. Our spatial analysis included 447 neighbourhood areas of similar population size in the city of Berlin. We included all laboratory-confirmed cases of patients hospitalized due to Rotavirus infections and notified between 01/01/2007 and 31/12/2009. We excluded travel-associated and nosocomial infections. A spatial Bayesian Poisson regression model was used for the statistical analysis of incidences at neighbourhood level in relation to socio-demographic variables.ResultsAltogether, 2,370 patients fulfilled the case definition. The disease mapping indicates a number of urban quarters to be highly affected by the disease. In the multivariable spatial regression model, two risk factors were identified for infants (<4 year olds): Rotavirus incidence increased by 4.95% for each additional percent of unemployed inhabitants in the neighbourhood (95% credibility interval (CI): 3.10%-6.74%) and by 0.53% for each additional percent of children attending day care in the neighbourhood (95% CI: 0.00%-1.06%). We found no evidence for an association with the proportion of foreign residents, population density, the residential quality of accommodations and resident changes in the neighbourhood.ConclusionsNeighbourhoods with a high unemployment rate and high day care attendance rate appear to be particularly affected by Rotavirus in the population of Berlin. Public health promotion programs should be developed for the affected areas. Due to the ecological study-design, risk pathways on an individual patient level remain to be elucidated.

Psychomotor speed in a random sample of 7979 subjects aged 30 years and over

Slowing of psychomotor speed among older individuals has been shown in numerous studies. However, in most cases these studies were based on small and selected groups of people and, in some cases, the test procedures did not allow separation of decision time and motor components of the overall performance. The purpose of the present study was to analyse in a large, randomly selected population sample the differences in decision and movement times in simple and multiple-choice test conditions. The association of educational background with psychomotor speed was also examined. Data on psychomotor speed were collected from a representative nation- wide sample of the Finnish population aged 30 years and over (n=7979) with the help of a computerized device in simple and multiple-choice test conditions, with visual stimuli. Background information (education) was collected by a structured interview. Results showed a systematic and significant decline in both decision time and movement time when proceeding from the youngest (30-39-year-olds) to the oldest (80+ yrs) age groups. This decline was more pronounced in the multiple-choice test than in the simple test. In both test conditions, movement times were shorter in men than in women. In the young and middle-aged groups, participants with longer formal education were faster than the less educated subjects. On the basis of the large representative random sample of this study, it may be concluded that decline in psychomotor speed during aging can already be seen at a quite young age. Decline accelerates after the age of about 70. Differences in socio-economic background factors, such as education, may modify the differences observed between younger and older individuals. These results emphasize the need for the separation of decision time and movement time in psychomotor speed tests, when differences between age groups as well as between men and women are analysed.

Physical activity and quality of life in subjects with chronic disease: Chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus

Objective. Chronic diseases interfere with the life situation of the affected person in different ways. The aim was to compare the burden of disease in three chronic diseases – chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), diabetes mellitus (DM) – and in healthy subjects, with a particular interest in physical activity, quality of life, and psychological health. Design. Cross-sectional, observational study. Setting and subjects. Postal survey questionnaire to a stratified, random population of 68 460 subjects aged 18–84 years in Sweden. The subjects included were 40–84 years old (n = 43 589) and data were analysed for COPD (n = 526), RA (n = 1120), DM (n = 2149) and healthy subjects (n = 6960). Result: Some 84% of subjects with COPD, 74% (RA), 72% (DM), and 60% in healthy subjects (p < 0.001, COPD versus RA, DM, and healthy subjects) had a physical activity level considered too low to maintain good health according to guidelines. Quality of life (EuroQol five-dimension questionnaire, EQ-5D) was lower in COPD and RA than in DM. Anxiety/depression was more common in subjects with COPD (53%) than in those with RA (48%) and DM (35%) (p < 0.001, COPD versus RA and DM), whereas mobility problems were more common in RA (55%) than COPD (48%) and DM (36%) (p < 0.001, RA versus COPD and DM). All differences between groups remained significant after adjusting for age, sex, and socioeconomic background factors. Conclusion. Subjects with chronic diseases had a low level of physical activity, most evident in subjects with COPD. COPD and RA had a higher negative impact on quality of life than DM. Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease.

Out‐of‐home care among immigrant children in Sweden: a national cohort study

We used data from several national registers for ten entire birth cohorts (n &gt; 1 million) to examine the representation of first generation immigrant children among first time entries into out‐of‐home care (foster or residential care) at ages 7–12 and 13–17. Logistic regression models were used to adjust results for socioeconomic background factors. Immigrant children were categorised in six groups relating to birth country/continent. Compared with Swedish‐born peers, immigrant children from non‐European countries had between two‐ and three‐fold sex and birth‐year adjusted odds for being placed in care for the first time at ages 7–12. After adjustments for five socioeconomic background variables, none of these overrisks remained. Instead there was a tendency towards immigrant background being associated with reduced risks, statistically significant for immigrant children born in non‐Nordic European countries. Immigrant children had between two‐ and six‐fold age and birth‐year adjusted odds for entering care for the first time during adolescence. After adjusting the results for socioeconomic background, only immigrant children born in Sub‐Saharan Africa or in Asia outside the Middle East had significant overrisks for care entries at ages 13–17 (odds ratio = 1.5).

Factors Influencing the Adoption of Pasture Crop Rotation in the Semiarid Area of China's Loess Plateau

ABSTRACT Alfalfa (Medicago Sativa L.) pasture crop rotations (PCR) have been promoted in the semiarid region of northern China for many years, with seemingly limited success. Using a logistic regression model, this paper evaluated the determinants of adoption of PCR among smallholder farmers in rain-fed farming systems, based on a survey of 238 farmers in the hilly area of the Loess Plateau in 2004 and 2005. Results indicated that farmers' socio-economic background, farm-related conditions, and institutional factors significantly affect their decision of whether or not to adopt PCR. First, the age of farmers, the size of their family, the number of ruminants owned, and farmers' attitude toward PCR have significant positive effects on the adoption of PCR, where the level of the family income is low. Second, the slope of the field and fallow practice variables also play a critical role in the adoption of PCR, suggesting the importance of targeting the promotion of PCR among farmers in areas affected by soil erosion. The analysis also showed that farmers' perception of the problem of soil erosion is positively correlated with adoption of PCR, having the most significant impact with the highest estimated elasticity. The likelihood a farmer who perceived soil erosion as a problem would adopt PCR was 225 greater than that of a farmer who did not have such perceptions. Third, the institutional variables, which are represented by contacts with extension workshops, a participatory approach, the credit and training facilities obtained, and participation in the Grain-for-Green project (PGFG), all had significant positive effects on the adoption of PCR. On the other hand, participation in the rainwater-harvesting project and in the supplementary irrigation project did not show any correlation with the adoption of PCR by farmers. Variables such as education level, the size of farms, farm tenure, off-farm employment, and distance between the farm and the farmers' residence did not significantly influence the adoption of PCR. This information will help prioritize factors that affect decision-making in the adoption of PCR and will provide insights into ways of increasing the adoption of PCR by farmers.

Low back pain and its risk indicators: a survey of 7,040 Finnish male conscripts

Studies describing risk indicators of low back pain (LBP) have focused on adults, although the roots of LBP lie in adolescence and early adulthood. The objective of the present study was to assess the lifetime occurrence and risk indicators of LBP in young adult males. The survey sample comprised 7,333 male conscripts (median age 19), of which 7,040 (96%) answered a questionnaire during the first days of their conscription. The outcome was lifetime LBP prompting at least one visit to a physician. Associations between 18 background variables and LBP were analysed by logistic regression. Altogether 894 (12.7%) respondents reported LBP. Health status was a strong determinant of LBP. The strongest individual risk indicators for LBP were having two or more other than back-related diseases diagnosed by a physician during past year (OR 2.0; 95% CI 1.6-2.5), below-average self-perceived health (OR 1.6; 95% CI 1.3-2.0) and use of smokeless tobacco (OR 1.4; 95% CI 1.2-1.7). Socioeconomic status was not associated with LBP and health behaviours only weakly. The strongest risk indicators for LBP were related to health problems. Of the socioeconomic background factors, none were associated with LBP. It is evident that LBP is associated with other health problems as well, indicating that its background may be multifactorial. This presents challenges for prevention programme planning and implementation. Longitudinal cohort studies are urgently needed to enhance understanding of adolescent risk indicators of LBP.

Unexpected low prevalence of HIV among fertile women in Luanda, Angola. Does war prevent the spread of HIV?

We studied HIV prevalence and risk factors for HIV infection among fertile women in Luanda for the purposes of obtaining background data for planning of interventions as well as to look into the association of armed conflicts and HIV prevalence in sub-Saharan Africa. The HIV-1 prevalence was 1.7% in an antenatal care group (n = 517) and 1.9% in a family planning group (n = 518). Socioeconomic and sexual background factors did not significantly differ HIV-positive from HIV-negative women. Data on armed conflict factors were matched with HIV prevalence figures among pregnant women in sub-Saharan Africa. The level of armed conflicts was found to be inversely related to HIV prevalence. The low HIV seroprevalence in Luanda is in sharp contrast to the capitals of neighbouring countries. While the spread of HIV may have been hampered by the long armed conflict in the country, it is feared to increase rapidly with the return of soldiers and refugees in a post-war situation. The challenge for preventive actions is urgent. This example may be relevant to other areas with a recent end-of-war situation.

Civic Knowledge of High School Students in Israel: Personal and Contextual Determinants

Past research on civic education suggests that students' performance is largely influenced by individual socioeconomic background and motivational factors. There has been little attention to the effects of school and classroom ideological and social attributes, such as the socioeconomic make‐up of the school or classroom, or how interested in politics are a student's classmates. The results of the present study support the contention that contextual effects play a vital role in determining students' civic knowledge scores. Analysis of Israeli 11th graders' performance on the International Association for the Evaluation of Educational Achievement (IEA) civic knowledge test shows that while individual backgrounds and motivations play a significant role, school and classroom contexts greatly contribute to civic knowledge acquisition.

An association between socioeconomic, health and health behavioural indicators and fractures in young adult males

The aim of this survey study with 7,083 male respondents was to examine the association between socioeconomic, health and health behavioural risk indicators and fractures. In the multivariate regression model, fractures were associated strongest with frequency of drunkenness, regular sports training, frequent use of health care services and obesity. Little is known about the risk factors for fractures in young adults. Our aim was to identify the association between socioeconomic background, health and health behaviours and fractures. The survey sample comprised 7,378 conscript males (median age 19), of which 7,083 (96%) answered. The outcome was self-reported fracture. Associations between 20 background variables and fractures were analysed with logistic regression. Altogether 2,456 (34.7%) participants reported fracture(s) during their lifetime. The most common anatomical locations of fracture were the forearm, the hand and the ankle. The strongest risk indicators for fractures were frequent drunkenness (OR 1.7; 95% CI: 1.3-2.0), regular sports training (OR 1.6; 95% CI: 1.3-1.9), frequent use of health care services (OR 1.5; 95% CI: 1.3-1.8) and obesity (OR 1.5; 95% CI: 1.2-1.9). This is among the first studies to describe risk indicators for fractures in young adults. The strongest risk factors for fractures were associated with health damaging behaviour, high-intensity physical activity and use of health care services. Of socioeconomic background factors, only living in the capital city area was associated with fractures. Preventive measures should be targeted at the males frequently using health care services or actively participating in sports.

Type A Eagerness-Energy Across Developmental Periods Predicts Adulthood Carotid Intima-Media Thickness

We examined the Type A behavior across developmental periods as a predictor of adult carotid artery intima-media thickness (IMT). In this prospective cohort study of 408 men and 606 women, socioeconomic background and biological risk factors of participants were assessed at baseline at age 6 to 18 years of age, Type A behavior (Hunter-Wolf A-B Rating Scale) at the 6-, 9-, and 21-year follow-ups (subjects being 12 to 24, 15 to 27, and 27 to 39 years, respectively), and carotid IMT, adulthood socioeconomic situation, and biological risk factors at the 21-year follow-up when participants were at age 27 to 39 years of age. In men, the eagerness-energy component of Type A behavior, measured at any time point, was associated with thicker carotid IMT (P<0.008, P<0.04, P<0.03, and P<0.02 for the first, second, and third assessment, and for the average score, respectively), and this association was independent of early and adult risk factors. In women, the hard-driving component at baseline (P<0.04) but not later was independently related to thinner carotid IMT. The other components of Type A behavior (impatience-aggression and leadership) were not associated with IMT. Eagerness-energy component of Type A behavior over different developmental transitions seems to be a robust predictor of IMT in men.

Allergic sensitization and microbial load – a comparison between Finland and Russian Karelia

Epidemiological data have indicated that some infections are associated with a low risk of allergic diseases, thus supporting the idea (hygiene hypothesis) that the microbial load is an important environmental factor conferring protection against the development of allergies. We set out to test the hygiene hypothesis in a unique epidemiological setting in two socio-economically and culturally markedly different, although genetically related, populations living in geographically adjacent areas. The study cohorts included 266 schoolchildren from the Karelian Republic in Russia and 266 schoolchildren from Finland. The levels of total IgE and allergen-specific IgE for birch, cat and egg albumen were measured. Microbial antibodies were analysed against enteroviruses (coxsackievirus B4), hepatitis A virus, Helicobacter pylori and Toxoplasma gondii. Although total IgE level was higher in Russian Karelian children compared to their Finnish peers, the prevalence of allergen-specific IgE was lower among Russian Karelian children. The prevalence of microbial antibodies was, in turn, significantly more frequent in the Karelian children, reflecting the conspicuous difference in socio-economic background factors. Microbial infections were associated with lower risk of allergic sensitization in Russian Karelian children, enterovirus showing the strongest protective effect in a multivariate model. The present findings support the idea that exposure to certain infections, particularly in childhood, may protect from the development of atopy. Enterovirus infections represent a new candidate to the list of markers of such a protective environment. However, possible causal relationship needs to be confirmed in further studies.

Brain–behavior relationships in reading acquisition are modulated by socioeconomic factors

Functional neuroimaging may provide insights into the achievement gap in reading skill commonly observed across socioeconomic status (SES). Brain activation during reading tasks is known to be associated with individual differences in children's phonological language skills. By selecting children of equivalent phonological skill, yet diverse socioeconomic backgrounds, we use functional magnetic resonance imaging (fMRI) to demonstrate that a child's experience, as operationalized by SES, can systematically modulate the relationship between phonological language skills and reading-related brain activity in left fusiform and perisylvian regions. Specifically, at lower socioeconomic levels, individual differences in skill result in large differences in brain activation. In contrast, as SES increases, this relationship between phonological language skill and activation is attenuated. Socioeconomic background factors are thus found to modulate brain-behavior relationships in reading, indicating that cognitive, social, and neurobiological influences on reading development are fundamentally intertwined.

Knowing a medical doctor is associated with reduced mortality among sick children consulting a paediatric ward in Guinea-Bissau, West Africa

To examine equity in access to public health services in Guinea-Bissau. The study was conducted in 2000-2001 at the emergency clinic of the only paediatric ward in Bissau. Mothers of all children from the study area were interviewed about previous care seeking and relations with anybody working in the health sector. All management actions in the emergency clinic were registered. In-hospital and subsequent community mortality was ascertained through community surveillance. The measured outcome was mortality risk within 30 days of first consultation. We followed 1572 children with a first consultation. Of these, 8.2% died within 30 days. Acquaintance with a physician reduced 30-day mortality risk by 48% (95% CI: 18-66). The effect was strongest among post-neonatal children (54%; 95% CI: 18-74). Mortality within 30 days of consultation was also independently predicted by consultation after 7 PM, nurse team on duty, day of week and young mother. In a multivariate model, socioeconomic status and school education were not associated with 30-day mortality when acquaintance with a medical doctor was taken into account. Favouritism may be a significant factor for quality of care and child mortality in developing countries. Interventions to improve hospital and health worker performance should be given high priority.

Association between Height and Coronary Heart Disease Mortality: A Prospective Study of 35,000 Twin Pairs

An inverse association between height and risk of coronary heart disease (CHD) is well demonstrated, but it is not known whether this association is because of genetic factors, socioeconomic background, or other environmental factors. Four population-based twin cohorts with register-based follow-up data on CHD mortality from Denmark (1966-1996), Finland (1975-2001), and Sweden (1963-2001 and 1972-2001) were used to investigate this question; response rates varied between 65% and 86%. Together, the cohorts included 74,704 twin individuals (35,042 complete twin pairs) with 5,943 CHD deaths during 1.99 million person-years of follow-up. Cox and conditional logistic regression models were used. Per 1-standard deviation decrease in height, height was inversely associated with CHD mortality in men (hazard ratio = 1.08, 95% confidence interval (CI): 1.04, 1.12) and in women (hazard ratio = 1.06, 95% CI: 1.01, 1.10). A twin who had died from CHD was on average shorter than the co-twin within monozygotic pairs (odds ratio = 1.27, 95% CI: 1.12, 1.44, with no sex difference), whereas a weaker association was found within dizygotic pairs in men (odds ratio = 1.01, 95% CI: 0.91, 1.13) and in women (odds ratio = 1.14, 95% CI: 1.01, 1.28). The inverse association between height and CHD mortality found within monozygotic discordant twin pairs suggests that this association is because of environmental factors that directly affect height and CHD risk.

Teenage parenthood among child welfare clients: A Swedish national cohort study of prevalence and odds

To assess prevalence and odds for teenage parenthood among former child welfare clients, we used national register data for all children born in Sweden 1972–1983 ( n = 1 , 1 7 8 , 2 0 7 ), including 49,582 former child welfare clients with varying intervention experiences. Logistic regression models, adjusted for demographic, socio-economic and familial background factors, were used to estimate odds ratios. Among youth who received interventions in adolescence, 16–19% of the girls and 5–6% of the boys became teenage parents, compared to 3% for girls and 0.7% for boys without child welfare experiences. Youths who entered child welfare services in their teens had four- to fivefold adjusted odds for becoming a teenage parent. For other child welfare clients, adjusted odds were mostly twofold. Youth of both sexes who receive child welfare services in adolescence are a high-risk group for teenage parenthood. Child welfare agencies should, as a minimum, provide each individual client youth with access to birth control counselling and contraceptives.

Longer-term Labour-market Consequences of Economic Inactivity during Young Adulthood: A Swedish National Cohort Study

We used national register data for more than 560,000 young persons living in Sweden to examine the longer-term labour-market consequences of being economically inactive. The study group consisted of the entire population born between 1969 and 1973 living in Sweden in 2003. Two observation groups of economically inactive young adults in the age range 20–24 years were identified and compared with cohort peers. The observation period was 1993–94, when youth unemployment peeked in Sweden; the follow-up year was 2001, the latest possible due to availability of statistics. One observation group consisted of those who had been inactive one year out of the two possible (n=41,496), and the other consisted of young people who had experienced two consecutive years of inactivity (n=19,188). Both inactivity and various labour-market positions were defined through Sweden's Total Enumeration Income Register. Logistic regression models were used to compute odds ratios for different marginalized labour-market outcomes in the evaluation year (i.e. seven years after the inactivity period). Our analyses show that individuals who were economically inactive when they were 20–24 years old in 1993–94 have a significantly elevated risk of being economically inactive when followed-up seven years later. Also, in comparison with individuals in other unstable labour-market positions there is a significant excess risk of a marginalized outcome among the inactive groups. Especially for the two-year inactive group, the odds ratio for remaining inactive seven years later was strikingly high. Although the results show that the inactivity rate is especially high among foreign-borns and those with the lowest level of education, the higher risks for inactivity remain even when controlling for demographic and socio-economic background factors and potential health-selection bias. Economic inactivity in young adulthood is discussed as a step in a marginalization process that has begun in earlier ages but where the time spent in economic inactivity plays an important role in the process.

Prevalence and risk factors for asthma in schoolchildren in southern Brazil

To study the prevalence and risk factors for asthma in a cohort of 494 children born in 1993 and followed up to the age of six years in Pelotas, state of Rio Grande do Sul, Brazil. A standardized and validated asthma questionnaire, based on the International Study of Asthma and Allergies in Childhood (ISAAC), was applied. Other information was also collected about socioeconomic background, genetic, nutritional, gestational and allergic factors, and previous infectious episodes. The prevalence of asthma found in this study was 12.8% (95%CI: 10-15.9%). In the multivariate analysis, risk factors such as non-white skin color (RR = 1.9 95% CI: 1.1-3.3%), family history of asthma (RR = 2.8 95% CI: 1.5-5.1), allergic rhinitis in children (RR = 2.6 95% CI: 1.5-4.4) and maternal smoking during pregnancy (RR = 1.7 95%CI: 1-2.9) were associated with asthma. Childhood asthma is highly prevalent in Pelotas, and it is a serious public health problem. Therefore, specific programs should be developed for its control.

An analysis of preventive dental visits by provider type, 1996

Understanding preventive dental visit utilization patterns facilitates planning of the dental health services delivery system. The authors examine these patterns by analyzing the receipt of preventive dental services in the United States by type of dental provider. The authors analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) for the U.S. community-based population. They developed national estimates for the population with preventive dental visits by provider type, including the population with a preventive dental visit and mean number of preventive dental visits per person for socioeconomic and demographic categories. Respondents who are white, are older, are female, have dental insurance, are from higher income and education backgrounds, and reside in small metropolitan areas were more likely (P < .05) to receive preventive care from a dental hygienist than from a dentist. MEPS data showed that people's socioeconomic background and other demographic factors were associated with having a preventive dental visit with a dentist or dental hygienist. These factors also influence the per-person number of preventive visits by type of dental practitioner. These elements must be considered when planning for future dental work force needs. Estimating future dental work force needs through this analysis assists dentists in meeting patient demand and maximizing the productive output of all services rendered in their practices, including preventive services.