Historical records of polycyclic aromatic hydrocarbon deposition in a shallow eutrophic lake: Impacts of sources and sedimentological conditions

Sediment core samples collected from Lake Chaohu were analyzed for 15 priority polycyclic aromatic hydrocarbons (PAHs) to assess the spatial and temporal distributions of the PAHs during lacustrine sedimentary processes and regional economic development. Assessing the PAH sedimentary records over an approximately 100-year time span, we identified two stages in the PAH inputs and sources (before the 1970s and after the 1970s) in the eastern lake region near a village, whereas three stages (before the 1950s, 1950s-1990s and after the 1990s) were identified in the western lake region near urban and industrial areas. Rapid increases in the PAH depositional fluxes occurred during the second stage due to increased human activities in the Lake Chaohu basin. The composition and isomeric ratios of the PAHs revealed that pyrolysis is the main source of PAHs in this lake. Strong positive relationships between PAH concentration and the total organic carbon concentration, sediment grain size (<4μm), as well as the local population and Gross Domestic Product indicated that the sedimentary conditions impact the depositional characteristics of the PAHs; simultaneously, socioeconomic activities, such as energy consumption and the levels of urban industrialization and civilization, affect both the composition and abundance of the PAHs.

Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy

Background and Objectives:

The goal of this study is to obtain updated surveillance statistics for hysterectomy procedures in the United States and identify factors associated with undergoing a minimally invasive approach to hysterectomy.

Methods:

A cross-sectional analysis of the 2009 United States Nationwide Inpatient Sample was performed. Subjects included all women aged 18 years or older who underwent hysterectomy of any type. Logistic regression and multivariate analyses were performed to assess the proportion of hysterectomies performed by various routes, as well as factors associated with undergoing minimally invasive surgery (laparoscopic, vaginal, or robotic).

Results:

A total of 479 814 hysterectomies were performed in the United States in 2009, 86.6% of which were performed for benign indications. Among the hysterectomies performed for benign indications, 56% were completed abdominally, 20.4% were performed laparoscopically, 18.8% were performed vaginally, and 4.5% were performed with robotic assistance. Factors associated with decreased odds of a minimally invasive hysterectomy included the following: minority race (P < .0001), fibroids (P < .0001), concomitant adnexal surgery (P < .0001), self-pay (P = .01) or Medicaid as insurer (P < .0001), and increased severity of illness (P < .0001). Factors associated with increased odds of a minimally invasive hysterectomy included the following: age >50 years (P < .0001), prolapse or menstrual disorder (P < .0001), median household income of $48 000–$62 999 (P = .007) or ≥$63 000 (P = .009), and location in the West (P = .02). A length of stay >1 day was most common in abdominal hysterectomy cases (96.1%), although total mean charges were highest for robotic cases ($38 161).

Conclusion:

The US hysterectomy incidence in 2009 decreased from prior years' reports, with an increasing frequency of laparoscopic and robotic approaches. Racial and socioeconomic factors influenced hysterectomy mode.

Chronic Pain in a Low Socioeconomic Status Population in Singapore: A Cross-Sectional Study

PURPOSE

. The authors sought to determine the prevalence of chronic pain in a low socioeconomic-status rental-flat community in Singapore and its associations. In Singapore, ≥85% own homes; public rental flats are reserved for the low-income.

METHODS

. Chronic pain was defined as pain ≥3 months. From 2009-2014, residents aged ≥ 40 years in five public rental-flat enclaves were surveyed for chronic pain, as well as sociodemographic factors. Subsequently, the authors conducted an additional study among elderly (aged ≥60) in two public rental-flat enclaves in 2012. The authors compared against residents staying in adjacent owner-occupied public housing.

RESULTS

. Prevalence of chronic pain in the rental-flat population was 14.2% (133/936) compared with 14.4% (158/1101) in the owner-occupied population (p = 0.949). On multivariate analysis, among those aged 40-59 years, staying in the rental flat community was independently associated with higher prevalence of leg/ankle/foot pain, compared to staying in the owner-occupied flat community (aOR = 2.35, CI = 1.24-7.35, p = 0.008). In the rental-flat population, unemployment was associated with chronic pain (aOR = 1.92, 95%, CI = 1.05-2.78, p = 0.030); among the elderly, dependency in instrumental-activities-of-daily-living (iADLs) was associated with chronic pain (aOR = 2.38, CI = 1.11-5.00, p = 0.025), as well as female gender, being single, and having higher education (all p > 0.05).

CONCLUSIONS

. In this low socioeconomic-status population, chronic pain associated with unemployment and functional limitation. There was no difference in pain prevalence between the rental-flat population and adjacent owner-occupied precincts.

Social determinants of health in adults with type 2 diabetes--Contribution of mutable and immutable factors

AIMS

Socioeconomic, psychosocial, and neighborhood factors influence clinical outcomes and self-care behaviors in diabetes; however, few studies simultaneously assessed the impact of multiple social determinant of health factors on glycemic control. We used an explanatory model to examine the differential contribution of social determinants and clinical factors on glycemic control. Secondarily, we examined the contribution of mutable and immutable factors to identify meaningful future interventions.

METHODS

Six hundred and fifteen adults with type 2 diabetes in the southeastern United States were recruited. A hierarchical model was run with HbA1c as the dependent variable and independent variables entered in blocks: demographics (block 1), socioeconomic (block 2), psychosocial (block 3), built environment (block 4), clinical (block 5), and knowledge/self-care (block 6).

RESULTS

Significant associations for HbA1c included self-efficacy (β=-0.10, p<0.001), social support (β=0.01, p<0.05), comorbidity (β=-0.09, p<0.05), insulin use (β=0.95, p<0.001), medication adherence (β=-0.11, p<0.05), and being a former smoker (β=0.34, p<0.05); accounting for 24.4% of the variance.

CONCLUSIONS

Important factors that drive glycemic control are mutable, and amenable to health interventions. Greater attention should be given to interventions that increase self-efficacy and social support, reduce the burden of comorbidities, and enhance medication adherence and smoking cessation.

Job-loss and weight gain in British adults: Evidence from two longitudinal studies

Overweight and obesity have been associated with unemployment but less is known about changes in weight associated with changes in employment. We examined weight changes associated with job-loss, retirement and maintaining employment in two samples of working adults in the United Kingdom. This was a prospective study of 7201 adults in the European Prospective Investigation of Cancer (EPIC)-Norfolk study (aged 39–76 years) and 4539 adults in the British Household Panel Survey (BHPS) who were followed up over 43 months and 26 months, respectively. In both samples, changes in measured (EPIC) and self-reported (BHPS) weight were computed for each participant and assessed in relation to three employment transitions: maintaining paid employment, retirement and job-loss. Regression models adjusted for potential confounders. Further analyses evaluated the contribution of diet, physical activity and smoking to weight gain. In EPIC-Norfolk, weight change differed across the three employment transitions for women but not men. The mean (95% CI) annualised change in weight for women who became unemployed over the follow-up period was 0.70 (0.55, 0.85) kg/y while those who maintained employment gained 0.49 (0.43, 0.55) kg/y (P = 0.007). Accounting for changes in smoking, diet and physical activity did not substantially alter the difference in weight gain among groups. In BHPS, job-loss was associated with weight gain of 1.56 (0.89, 2.23) kg/y, while those who maintained employment 0.60 (0.53, 0.68) kg/y (P < 0.001). In both samples, weight changes associated with retirement were similar to those staying in work. In BHPS, job-loss was also associated with significant declines in self-reported well-being and increases in sleep-loss.

Two UK-based samples of working adults reveal strong associations between job-loss and excess weight gain. The mediating behaviours are so far unclear but psychosocial mechanisms and sleep-loss may contribute to the excess weight gain among individuals who become unemployed.

•

Job-loss is associated with a more weight gain in working UK adults.

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The association between job-loss and weight may be stronger for women.

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Changes in smoking, diet and physical activity did not explain weight gain.

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Job-loss is associated with loss of sleep due to worry.

•

Behavioural and psychosocial impacts of job-loss need further elucidation.

Prevalence and socio-demographic correlates of time spent cooking by adults in the 2005 UK Time Use Survey. Cross-sectional analysis

This study aimed to document the prevalence and socio-demographic correlates of time spent cooking by adults in the 2005 UK Time-Use Survey. Respondents reported their main activities, in 10 minute slots, throughout one 24 hour period. Activities were coded into 30 pre-defined codes, including 'cooking, washing up'. Four measures of time spent cooking were calculated: any time spent cooking, 30 continuous minutes spent cooking, total time spent cooking, and longest continuous time spent cooking. Socio-demographic correlates were: age, employment, social class, education, and number of adults and children in the household. Analyses were stratified by gender. Data from 4214 participants were included. 85% of women and 60% of men spent any time cooking; 60% of women and 33% of men spent 30 continuous minutes cooking. Amongst women, older age, not being in employment, lower social class, greater education, and living with other adults or children were positively associated with time cooking. Few differences in time spent cooking were seen in men. Socio-economic differences in time spent cooking may have been overstated as a determinant of socio-economic differences in diet, overweight and obesity. Gender was a stronger determinant of time spent cooking than other socio-demographic variables.

Prevalence and socio-demographic correlates of time spent cooking by adults in the 2005 UK Time Use Survey. Cross-sectional analysis

This study aimed to document the prevalence and socio-demographic correlates of time spent cooking by adults in the 2005 UK Time-Use Survey. Respondents reported their main activities, in 10 minute slots, throughout one 24 hour period. Activities were coded into 30 pre-defined codes, including 'cooking, washing up'. Four measures of time spent cooking were calculated: any time spent cooking, 30 continuous minutes spent cooking, total time spent cooking, and longest continuous time spent cooking. Socio-demographic correlates were: age, employment, social class, education, and number of adults and children in the household. Analyses were stratified by gender. Data from 4214 participants were included. 85% of women and 60% of men spent any time cooking; 60% of women and 33% of men spent 30 continuous minutes cooking. Amongst women, older age, not being in employment, lower social class, greater education, and living with other adults or children were positively associated with time cooking. Few differences in time spent cooking were seen in men. Socio-economic differences in time spent cooking may have been overstated as a determinant of socio-economic differences in diet, overweight and obesity. Gender was a stronger determinant of time spent cooking than other socio-demographic variables.

Cumulative exposure to childhood stressors and subsequent psychological distress. An analysis of US panel data

Research has shown that childhood stress increases the risk of poor mental health later in life. We examined the effect of childhood stressors on psychological distress and self-reported depression in young adulthood. Data were obtained from the Child Development Supplement (CDS) to the national Panel Study of Income Dynamics (PSID), a survey of US families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood (TA) data drawn from a national sample of young adults, 18-23 years old. This study included data from participants in the CDS and the TA (n = 2128), children aged 4-13 at baseline. Data on current psychological distress was used as an outcome variable in logistic regressions, calculated as odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses were used to identify clusters based on the different childhood stressors. Associations were observed between cumulative exposure to childhood stressors and both psychological distress and self-reported depression. Individuals being exposed to three or more stressors had the highest risk (crude OR for psychological distress: 2.49 (95% CI: 1.16-5.33), crude OR for self-reported depression: 2.07 (95% CI: 1.15-3.71). However, a large part was explained by adolescent depressive symptoms. Findings support the long-term negative impact of cumulative exposure to childhood stress on psychological distress. The important role of adolescent depression in this association also needs to be taken into consideration in future studies.

The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking

BACKGROUND

Subclinical and clinical depression is common, widely distributed in the general population, and usually associated with role impairment and help-seeking. Reliable information at the population level is needed to estimate the disease burden of depression and associated care needs in Turkey.

METHOD

The cross-sectional study aimed to assess the prevalence of subthreshold (SubD) and clinical major depressive disorder (MDD) in Izmir, Turkey. In the 5242 eligible households, a total of 4011 individuals were successfully interviewed, yielding a response rate of 76.5%. Prevalence estimates of MDD and SubD depression were formed by using the responses to the questions of the CIDI section E. Short Form 36 (SF-36) to assess health status and functional impairments in eight scaled scores during the last four weeks. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, as well as prescribed medicines and any hospitalization.

RESULTS

The one year prevalence estimate for CIDI/DSM IV MDD was 8.2% (95% CI, 7.4-9.1). Less educated, low income, uninsured, low SES, unemployed/disabled and housewives, slum area residents had higher one year MDD prevalence. Determined prevalence of help seeking from mental health services of SubD and MDD cases were 23.6%, 30.6% respectively. Only 24.8% of clinically depressive patients received minimally adequate treatment.

LIMITATIONS

Cross sectional design.

CONCLUSION

Higher MDD prevalence correlates with younger ages, female gender, unemployment, less education, lower monthly income, lower SES and uninsurance. Help seeking from mental health services were low. There are treatment gap and impairment in depressive group.

Black carbon exposure, socioeconomic and racial/ethnic spatial polarization, and the Index of Concentration at the Extremes (ICE)

BACKGROUND

Scant data quantify associations between economic and racial/ethnic spatial polarization and individual's exposure to pollution.

METHODS

We linked data on the socioeconomic position (SEP) of 1757 urban working class white, black, and Latino adults (age 25-64; Boston, MA: 2003-2004; 2008-2010) to: (1) spatiotemporal model-based estimates of cumulative black carbon exposure at their exact residential address, and (2) their census tract values for the Index of Concentration at the Extremes (ICE) for SEP and race/ethnicity.

RESULTS

ICE measures, but not individual- and household-SEP, remained independently associated with black carbon exposure.

CONCLUSIONS

The ICE may be useful for environmental health research.

Socioeconomic and psychological impact of treatment for unilateral intraocular retinoblastoma

PURPOSE

To identify the socioeconomic and psychosocial impacts of clinical treatment decisions for advanced unilateral intraocular retinoblastoma.

DESIGN

Retrospective observational case series.

METHODS

SETTING

institutional study at Alexandria Main University Hospital.

STUDY POPULATION

records of 66 unilateral retinoblastoma cases treated from May 2005 to May 2013 were retrospectively reviewed. Sixty cases were eligible (International Intraocular Retinoblastoma Classification [IIRC] group C, D or E).

PROCEDURES

two treatment groups were compared: enucleation vs. salvage treatment. Salvage treatment eyes were further subdivided based on IIRC group. Six socioeconomic parameters (financial burden, financial impact, psychological, social, medical and tumor impacts) were scored. Parameter scores ranged from 0 to 3, for overall score range 0 (no adverse impact) to 18 (severe adverse impact).

MAIN OUTCOME MEASURES

derived Socioeconomic scores were correlated with treatment and outcomes.

RESULTS

The enucleation group (28 eyes) had a median overall Socioeconomic score of 4/18, significantly lower than the salvage treatment group (32 eyes), median score 11/18 (P<0.01). Socioeconomic score varied with IIRC group. Attempted eye salvage failed in 25 children, due to uncontrolled tumor (44%) and socioeconomic impact of cumulative therapies (56%). Treatment duration and Socioeconomic score were higher for the 5 children in the salvage treatment group who developed metastatic disease compared to those without metastasis (P<0.01).

CONCLUSIONS

The socioeconomic and psychosocial impacts of attempted ocular salvage for unilateral intraocular retinoblastoma are severe, in comparison to primary enucleation. Primary enucleation is a good treatment for unilateral retinoblastoma.

Pediatric cochlear implantation: role of language, income, and ethnicity

OBJECTIVE

To compare post-cochlear implantation (CI) early speech perception (ESP) outcomes between a non-English speaking, ethnic minority study group and an English speaking, ethnic majority control group.

STUDY DESIGN/METHODS

We performed a retrospective case-control study at an academic tertiary care children's hospital. Records were reviewed of 49 children who underwent CI from February 2005 to September 2011. Children with abnormal cognitive function (n=12), post-surgical complications (n=1), or incomplete SP testing (n=24) were excluded. The remaining 12 cases (mean implant age 4.3 y) were reviewed for language, income, ethnicity, and ESP scores. Their scores were compared to a subset of patients (n=18; mean implant age 2.2 y) serving as control from the Childhood Development after Cochlear Implantation (CDaCI) study at 1 year follow up where standard ESP testing was performed. Briefly, CDaCI includes a demographically balanced and multicenter-based pediatric cohort from which publications are beginning to define normative post-CI SP outcomes.

RESULTS

Of our 12 children, 7 were Hispanic, 2 Caucasian, 2 multi-ethnicity and 1 Russian. 4 were non-English speaking, 5 spoke English as a second language, and 7 were bilingual. Three received bilateral CI. Mean early speech perception (ESP) scores (reported on a scale of 1-4) collected at 6 and 12 months in the study group were 1.71 and 1.75, respectively; in the control group, 3.83 and 3.92. At both follow up intervals the study group performed significantly worse than the control group (6 mo P=0.048, 12 mo P=0.01).

CONCLUSIONS

This study suggests that among pediatric CI recipients, those from predominantly non-English speaking, socioeconomically disadvantaged backgrounds develop SP at slower than normal rates. Future interventions should be directed at overcoming these obstacles.

The social and economic determinants of suicide in Canadian provinces

BACKGROUND

In this paper we investigate the causal relationship between suicide and a variety of socioeconomic variables. We use a panel data set of Canadian provinces, 2000 - 2008, and a set of recent panel econometric techniques in order to account for a variety of statistical specification issues.

RESULTS

We find that the social and economic determinants of suicide in Canadian provinces vary across total, male, and female counts (natural logarithms) and rates. We also find that the results vary depending on the econometric method employed. As such, separate analyses for males and females is necessary for a better understanding of the factors that impact suicide (consistent with previous research) and that the choice of statistical method impacts the results. Lastly, it is important to note the particular provinces are driving the results for particular socioeconomic variables.

CONCLUSIONS

Such a result, if generalizable, has significant implications for suicide prevention policy.

Economic difficulties and subsequent disability retirement

BACKGROUND

This study examined whether economic difficulties are associated with subsequent disability retirement while controlling for covariates.

METHODS

Survey data among middle-aged employees of the City of Helsinki in 2000-2002 were linked with the Finnish Centre for Pensions register data on all-cause disability retirement among women (n=4816) and men (n=1354) until the end of 2010. Additionally, disability retirement due to musculoskeletal diseases and mental disorders (ICD-10) was examined among women. Frequency in difficulties paying pills and buying food and clothes, and covariates (occupational class, income, housing tenure, and work- and health-related covariates) were self-reported at baseline. Hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated from Cox regression analysis.

RESULTS

Frequent economic difficulties were associated with all-cause disability retirement after adjusting for age among both women (HR=2.11; 95% CI 1.63-2.73) and men (HR=2.69; 95% CI 1.65-4.41). Adjustment for covariates somewhat attenuated the associations, but they remained. Economic difficulties were also associated with disability retirement due to both mental disorders (HR=3.29; 95% CI 1.98-5.46) and musculoskeletal diseases (HR=1.85; 95% CI 1.24-2.75) among women. Adjustments made a minor contribution to the risk of disability retirement due to mental disorders, whereas the risk of disability retirement due to musculoskeletal diseases reduced after considering socioeconomic circumstances. Conclusions: economic difficulties are independently associated with disability retirement. Thus, they should be considered in attempts to tackle early exit from the labour market due to disability.

Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling

OBJECTIVE

To develop and test latent variables of the social determinants of health that influence diabetes self-care.

METHODS

615 adults with type 2 diabetes were recruited from two adult primary care clinics in the southeastern United States. Confirmatory factor analyses (CFA) identified the latent factors underlying socioeconomic determinants, psychosocial determinants, and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling (SEM) investigated the relationship between determinants and self-care.

RESULTS

Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support and social status. The initial model (chi2(254) = 388.04, p < 0.001, RMSEA = 0.03, CFI = 0.98) showed that lower psychological distress (r = -0.13, p = 0.019), higher social support (r = 0.15, p = 0.008), and higher self-efficacy (r = 0.47, p < 0.001) were significantly related to diabetes self-care. Social status was not significantly related to self-care (r = 0.003, p = 0.952). In the trimmed model (chi2(189) = 211.40, p = 0.126, RMSEA = 0.01, CFI = 0.99) lower psychological distress (r = -0.13, p = 0.016), higher social support (r = 0.15, p = 0.007), and higher self-efficacy (r = 0.47, p < 0.001) remained significantly related to diabetes self-care.

CONCLUSION

Based on theoretical relationships, three latent factors that measure social determinants of health (psychological distress, social support and self-efficacy) are strongly associated with diabetes self-care.

PRACTICE IMPLICATIONS

This suggests that social determinants should be taken into account when developing patient self-care goals.

Socioeconomic and demographic factors contributing to outcomes in patients with primary lymphoma of bone

Background

Primary lymphoma of bone (PLB) is a rare disease, comprising a malignant lymphoid infiltrate of bone. The goal of this study was to identify socioeconomic, demographic, and anatomic factors as prognostic indicators of survival for this disease using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

The SEER database was used to identify a study population of 692 patients diagnosed with PLB in the United States from 1989 to 2003. Survival was analyzed using the Kaplan–Meier method, with effects of potential prognostic factors on survival analyzed using the log-rank test. Multivariable analysis was performed by Cox proportional hazards regression.

Results

The overall 5-year survival rate was 49.6%, with a 10-year survival rate of 30.2%. Median overall survival was 4.9 years (95% CI: 3.9, 6.1). In multivariable analysis, age (p<0.0001), marital status (p=0.006), and appendicular vs. axial tumor location (p=0.004) were found to be independent predictors of survival.

Conclusions

This population-based study of PLB identified age, marital status, and tumor location as independent indicators of prognosis. This finding supports the clinical suspicion that an appendicular tumor location confers a better prognosis than an axial tumor location.

Cumulative socioeconomic disadvantage and cardiovascular disease mortality in the Alameda County Study 1965 to 2000

PURPOSE

Socioeconomic disadvantage is often evaluated at single points in the adult life course in health research. Social mobility models suggest that socioeconomic patterns may also influence disease risk. This study examines cumulative socioeconomic disadvantage (CSD) in relation to cardiovascular disease mortality (CVDM).

METHODS

Data were from the Alameda County Study (n = 2530). The CSD indices included father's education, the respondent's education, and either average or latent variable trajectory models of adulthood household income (1965-1994). Proportional hazards models were used to assess the associations between CSD and CVDM.

RESULTS

The CSD measures were not associated with CVDM in men. Among women, the magnitude of the association between CSD and CVDM was greater for the income trajectory (hazard ratio3 vs 0 = 4.73, 95% confidence interval = 2.20-10.18) compared with the average income (hazard ratio3 vs 0 = 3.78, 95% confidence interval = 1.67-8.53) CSD measure.

CONCLUSIONS

Measures of CSD that incorporate patterning of resources over the life course were associated with CVDM for women but not men. Patterning of available socioeconomic resources may differentially influence chronic disease risk and mortality by gender, and future work should continue to investigate how greater patterns variability in available resources influences health outcomes.

Socioeconomic development as a determinant of the levels of organochlorine pesticides and PCBs in the inhabitants of Western and Central African countries

Several studies of environmental samples indicate that the levels of many persistent organic pollutants (POPs) are increasing in Africa, but few studies have been conducted in humans. Simultaneously, many African countries are experiencing a rapid economic growth and implementing information and communication technologies (ICT). These changes have generated high amounts of electronic waste (e-waste) that have not been adequately managed. We tested the hypothesis that the current levels of two main classes of POPs in Western and Central African countries are affected by the degree of socioeconomic development. We measured the levels of 36 POPs in the serum of recent immigrants (N=575) who came from 19 Sub-Saharan countries to the Canary Islands (Spain). We performed statistical analyses on their anthropometric and socioeconomic data. High median levels of POPs were found in the overall sample, with differences among the countries. Organochlorine pesticide (OCP) and polychlorinated biphenyl (PCB) levels increased with age. People from low-income countries had significantly higher OCP levels and much lower PCB levels than those from high-income countries. We found a significant association between the implementation of ICT and PCB contamination. Immigrants from the countries with a high volume of imports of second-hand electronic equipment had higher PCB levels. The economic development of Africa and the e-waste generation have directly affected the levels of POPs. The POP legacies of these African populations most likely are due to the inappropriate management of the POPs' residues.

Characteristics of diabetic foot ulcers in Western Sydney, Australia

BACKGROUND

Australia is ranked ninth of 39 countries in the Western Pacific region most affected by diabetes. Patients with diabetes are at high risk of developing foot ulcerations that can develop into non-healing wounds. Recent studies suggest that the lifetime risk of developing a diabetic foot ulcer is as high as 25%. Few studies have reported the prevalence of, risk factors and socioeconomic status associated with, diabetic foot ulcers in Australia. The aim of this study was to evaluate the characteristics of diabetic foot ulcers in a tertiary referral outpatient hospital setting in Western Sydney, Australia.

METHODS

From January-December 2011, a total of 195 outpatients with diabetes were retrospectively extracted for analysis from the Westmead Hospital's Foot Wound Clinic Registry. Data on demographics, socioeconomic status, co-morbidities, foot ulcer characteristics and treatment were recorded on a standardised form.

RESULTS

Demographics and physical characteristics were: 66.2% male, median age 67 years (IQR: 56-76), median body mass index (BMI) of 28 kg/m(2) (IQR: 25.2-34.1), 75.4% had peripheral neuropathy and the median postcode score for socioeconomic status was 996 (IQR: 897-1022). Diabetic foot ulcer characteristics were: median cross sectional area of 1.5 cm(2) (IQR: 0.5-7.0), median volume of 0.4 cm(3) (IQR: 0.11-3.0), 45.1% on the plantar aspect of the foot, 16.6% UT Wound Grade of 0C to 3C (with ischaemia) and 11.8% with a Grade 0D to 3D (with infection and ischaemia) and 25.6% with osteomyelitis. Five patients required an amputation: 1 major and 4 minor amputations.

CONCLUSIONS

In accordance with other international studies, foot ulcers are more likely to present on the plantar surface of the foot and largely affect overweight older males with a long standing history diabetes in our outpatient hospital in Western Sydney.

Does early socio-economic disadvantage predict comorbid alcohol and mental health disorders?

BACKGROUND

Alcohol and mental health disorders are highly prevalent in the general population, with co-occurrence recognised as a major public health issue. Socio-economic factors are frequently associated with both disorders but their temporal association is unclear. This paper examines the association between prenatal socio-economic disadvantage and comorbid alcohol and mental health disorders at young adulthood.

METHODS

An unselected cohort of women was enrolled during early pregnancy in the large longitudinal Mater-University of Queensland Study of Pregnancy (MUSP), at the Mater Misericordiae Public Hospital in Brisbane, Australia. The mothers and their offspring were followed over a 21 year period. Offspring from the MUSP birth cohort who provided full psychiatric information at age 21 and whose mothers provided socioeconomic information at baseline were included (n=2399). Participants were grouped into no-disorder, mental health disorder only, alcohol disorder only or comorbid alcohol and mental health disorders according to DSM-IV diagnoses at age 21 as assessed by the Composite International Diagnostic Interview. We used multivariate logistic regression analysis to compare associations of disorder group with single measures of prenatal socio-economic disadvantage including family income, parental education and employment, and then created a cumulative scale of socioeconomic disadvantage.

RESULTS

Greater socio-economic disadvantage was more strongly associated with comorbidity (OR 3.36; CI95 1.37, 8.24) than with single disorders. This relationship was not fully accounted for by maternal mental health, smoking and drinking during pregnancy.

CONCLUSION

Multiple domains of socio-economic disadvantage in early life are associated with comorbid alcohol and mental health disorders.

Black carbon exposure more strongly associated with census tract poverty compared to household income among US black, white, and Latino working class adults in Boston, MA (2003-2010)

We investigated the association of individual-level ambient exposure to black carbon (spatiotemporal model-based estimate for latitude and longitude of residential address) with individual, household, and census tract socioeconomic measures among a study sample comprised of 1757 US urban working class white, black and Latino adults (age 25-64) recruited for two studies conducted in Boston, MA (2003-2004; 2008-2010). Controlling for age, study, and exam date, the estimated average annual black carbon exposure for the year prior to study enrollment at the participants' residential address was directly associated with census tract poverty (beta = 0.373; 95% confidence interval (CI) 0.322, 0.423) but not with annual household income or education; null associations with race/ethnicity became significant only after controlling for socioeconomic position.

Associations between socio-economic position and sedentary behaviour in a large population sample of Australian middle and older-aged adults: The Social, Economic, and Environmental Factor (SEEF) Study

OBJECTIVE

Socioeconomic position (SEP) is associated with health-related behaviours but little is known about the socioeconomic gradient of sedentary behaviour. This study aims to assess the associations between SEP and multiple indicators of sedentary behaviour among Australian mid-to-older age adults.

METHOD

Multivariate analysis of 60,404 (>47years, 26,366 in paid employment) participants in the Social, Economic, and Environmental Factor Study, examining the associations between SEP (educational attainment, household income, and an area-level index of socioeconomic advantage) and self-reported daily time for total sitting, TV viewing, computer use, and car driving. Data was collected in 2010 in New South Wales, Australia.

RESULTS

For participants in paid employment, we found positive associations with all SEP indicators for total sitting and computer use time, and inverse associations for TV viewing. Driving time was inversely associated with education level only. We observed similar but less pronounced patterns of associations among participants not in paid employment.

CONCLUSION

Higher SEP is linked to higher total sitting and computer time, particularly among those in paid employment, and lower TV viewing time.

A nationwide analysis of clinical outcomes among newborns with esophageal atresia and tracheoesophageal fistulas in the United States

BACKGROUND

The aim of this study was to examine national outcomes in newborn patients with esophageal atresia and tracheoesophageal fistula (EA/TEF) in the United Sates.

METHODS

Kids' Inpatient Database (KID) is designed to identify, track, and analyze national outcomes for hospitalized children in the United States. Inpatient admissions for pediatric patients with EA/TEF for kids' Inpatient Database years 2000, 2003, 2006, and 2009 were analyzed. Patient demographics, socioeconomic measures, disposition, survival and surgical procedures performed were analyzed using standard statistical methods.

RESULTS

A total of 4168 cases were identified with diagnosis of EA/TEF. The overall in-hospital mortality was 9%. Univariate analysis revealed lower survival in patients with associated acute respiratory distress syndrome, ventricular septal defect (VSD), birth weight (BW) < 1500 g, gestational age (GA), time of operation within 24 h of admission, coexisting renal anomaly, imperforate anus, African American race, and lowest economic status. Multivariate logistic regression identified BW < 1500 g (odds ratio [OR] = 4.5, P < 0.001), operation within 24 h (OR = 6.9, P < 0.001), GA <28 wk (OR = 2.2, P < 0.030), and presence of VSD (OR = 3.8, P < 0.001) as independent predictors of in-hospital mortality. Children's general hospital and children's unit in a general hospital were found to have a lower mortality rate compared with not identified as a children's hospital after excluding immediate transfers (P = 0.008).

CONCLUSIONS

BW < 1500 g, operation within 24 h, GA < 28 wk, and presence of VSD are the factors that predict higher mortality in EA/TEF population. Despite dealing with more complicated cases, children's general hospital and children's unit in a general hospital were able to achieve a lower mortality rate than not identified as a children's hospital.

Socioeconomic impact of children's burns-a pilot study

OBJECTIVE

This pilot study aimed to gain empirical data on the social and economic impacts of child burns on children and parents, in the context of the outpatient setting.

METHOD

A questionnaire was completed by 52 parents of paediatric patients attending the burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least the third time. Children's medical notes were used to extract demographic and medical data. Quantitative data was analyzed statistically and qualitative data was analyzed manually using content analysis.

RESULTS

The financial burden related to the injury posed the greatest impact on parents, and was mainly associated with making the journey to the hospital, with lower income households being most affected. Self-employed parents and those who had to attend more than 6 hospital appointments also ran into difficulties. On the whole, there was not a considerable social impact on the burn-injured child, which may reflect the minor nature of burns in this study (mean depth partial thickness, median TBSA 1.0%).

CONCLUSION

Parents were shown to perceive a greater impact from their child's burn injury than their child. Certain groups of parents were identified as requiring additional support following the burn injury.

Impact of the socioeconomic status on the severity and outcome of community-acquired pneumonia among Egyptian children: a cohort study

BACKGROUND

Community-acquired pneumonia (CAP) is one of the five leading causes of death among children in developing countries, accounting for approximately three million deaths per year. Identification of the modifiable risk factors of CAP may help to reduce the burden of this disease. In this study, the impact of the socioeconomic status (SES) on the severity and outcome of CAP among Egyptian children was studied.

METHODS

This was a prospective longitudinal cohort study which included 1,470 children diagnosed with CAP, aged two to 15 years (median age 5.4 years). The diagnosis of CAP was based on clinical and radiological findings. A structured questionnaire and the patients' medical records were used for the data collection. The subjects were divided into two groups: mild and severe CAP. Social and demographic variables were compared, and a multivariate logistic regression analysis was performed.

RESULTS

THE MULTIVARIATE ANALYSIS SHOWED THAT A LOW MATERNAL EDUCATION LEVEL (OR: 3.8; 95% CI: 2.12 -6.70; P = .0001), unavailability of adequate medical care (OR: 3.1; 95% CI: 1.99 -4.88; P = .0001), a low family income (OR: 2.2; 95% CI: 0.99 -4.78; P = .047), and parents' smoking habits (OR: 2.0; 95% CI: 1.15 -3.55; P = .014) were significant independent predictive risk factors for severe CAP among Egyptian children.

CONCLUSION

Public health measures against these socio-demographic risk factors should be identified as priorities in order to help reduce the disease burden of deaths from severe CAP among Egyptian children.

Socioeconomic impact of children's burns-a pilot study

OBJECTIVE

This pilot study aimed to gain empirical data on the social and economic impacts of child burns on children and parents, in the context of the outpatient setting.

METHOD

A questionnaire was completed by 52 parents of paediatric patients attending the burns outpatient department at Queen Victoria Hospital (QVH), East Grinstead, for at least the third time. Children's medical notes were used to extract demographic and medical data. Quantitative data was analyzed statistically and qualitative data was analyzed manually using content analysis.

RESULTS

The financial burden related to the injury posed the greatest impact on parents, and was mainly associated with making the journey to the hospital, with lower income households being most affected. Self-employed parents and those who had to attend more than 6 hospital appointments also ran into difficulties. On the whole, there was not a considerable social impact on the burn-injured child, which may reflect the minor nature of burns in this study (mean depth partial thickness, median TBSA 1.0%).

CONCLUSION

Parents were shown to perceive a greater impact from their child's burn injury than their child. Certain groups of parents were identified as requiring additional support following the burn injury.

Maternal Beliefs and Socioeconomic Correlated Factors on Child Mortality from Drowning in Caspian Sea Coastline

OBJECTIVE

To investigate maternal beliefs, practices about causes and determinant factors on drowning and maternal socioeconomic correlated factors on child mortality from drowning.

METHODS

From March 2005 to March 2009, in a register-based cohort study and household survey, individual records utilizing drowning registry data of northern Iran were enrolled.   Mothers (n=276) who responded to multiple questions in a household survey were included. The patterns, interrelationships and effects of socioeconomic correlated factors on child mortality were analyzed.

RESULTS

A significant difference in relation to mother's educational level and age and family income distribution was noticed. Participants in household survey also reported that establishment of a multi-sectorial collaboration, integration of public health messages into local television, additional rescue stations and lifeguard, hazard environment fencing, increasing adult supervision, more support on increasing swimming ability among the children were all effective on reducing of drowning death.

CONCLUSION

Due to the high rate of drowning in children and lack of attention among olders, a greater emphasis should be placed on educating mothers to assist a better supervision on their children.

Health inequalities in Japan: the role of material, psychosocial, social relational and behavioural factors

The extent that risk factors, identified in Western countries, account for health inequalities in Japan remains unclear. We analysed a nationally representative sample (Comprehensive Survey of Living Conditions surveyed in 2001 (n = 40,243)). The cross-sectional association between self-rated fair or poor health and household income and a theory-based occupational social class was summarised using the relative index of inequality [RII]. The percentage attenuation in RII accounted for by candidate contributory factors - material, psychosocial, social relational and behavioural - was computed. The results showed that the RII for household income based on self-rated fair or poor health was reduced after including the four candidate contributory factors in the model by 20% (95% CI 2.1, 43.6) and 44% (95% CI 18.2, 92.5) in men and women, respectively. The RII for the Japanese Socioeconomic Classification [J-SEC] was reduced, not significantly, by 22% (95% CI -6.3, 100.0) in men in the corresponding model, while J-SEC was not associated with self-rated health in women. Material factors produced the most consistent and strong attenuation in RII for both socioeconomic indicators, while the contributions attributable to behaviour alone were modest. Social relational factors consistently attenuated the RII for both socioeconomic indicators in men whereas they did not make an independent contribution in women. The influence of perceived stress was inconsistent and depended on the socioeconomic indicator used. In summary, social inequalities in self-rated fair or poor health were reduced to a degree by the factors included. The results indicate that the levelling of health across the socioeconomic hierarchy needs to consider a wide range of factors, including material and psychosocial factors, in addition to the behavioural factors upon which the current public health policies in Japan focus. The analyses in this study need to be replicated using a longitudinal study design to confirm the roles of different factors in health inequalities.

Money & Menopause: The Relationship Between Socioeconomic Class and Awareness about Menopause in Women in Mumbai, India

PURPOSE

The primary aim of this study is to determine the awareness regarding menopause and its treatment options among women in Mumbai, India and correlate the same with the social class of the subject. In addition, this study also attempts to identify the attitude of Indian women toward menopause.

METHODS

A cross-sectional study was conducted using a self-constructed semi structured questionnaire given to women between the ages of 35 and 55 years, currently residing in Mumbai. The 192 women interviewed were then divided into 6 groups as per Prasad's Socioeconomic Classification (based on per capita monthly income) with 53 % falling in class I and II and 47 % in class III, IV and V. Although the study was conducted primarily at a charitable hospital, no subject was found who fulfilled the Class VI criteria.

RESULT

The study shows that two-thirds of class I, four-fifths of class II, less than half of class III, and one third of class IV and V are aware about treatment options for menopause which is a significant variation (χ (2) value = 20.127, df = 1, P < 0.0001). We also found that once counseled, more than half the subjects of classes I to V were willing to accept treatment, which thus is not a significant variation (P = 0.4659). Of the total subjects, more than half were relieved, one fourth frightened, and less than one fifth were uncertain about their feelings toward menopause.

CONCLUSION

We thus conclude that there is a significant relationship between socioeconomic status and awareness about menopause treatment options while there is no relationship between socioeconomic status and acceptance of treatment for the same. A majority of the Indian women are relieved by the onset of menopause.

Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes

OBJECTIVE

The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life.

RESEARCH DESIGN AND METHODS

Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates.

RESULTS

In final adjusted models, significant associations for HbA1c included education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β = -0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI: -0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI: -0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived stress (β = -0.12, CI: -0.19 to -0.06).

CONCLUSIONS

Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a 40-year study

OBJECTIVES

To evaluate IQ and academic skills in adults who experienced an episode of moderate-to-severe infantile malnutrition and a healthy control group, all followed since childhood in the Barbados Nutrition Study.

METHODS

IQ and academic skills were assessed in 77 previously malnourished adults (mean age = 38.4 years; 53% male) and 59 controls (mean age = 38.1 years; 54% male). Group comparisons were carried out by multiple regression and logistic regression, adjusted for childhood socioeconomic factors.

RESULTS

The previously malnourished group showed substantial deficits on all outcomes relative to healthy controls (P < 0.0001). IQ scores in the intellectual disability range (< 70) were nine times more prevalent in the previously malnourished group (odds ratio = 9.18; 95% confidence interval = 3.50-24.13). Group differences in IQ of approximately one standard deviation were stable from adolescence through mid-life.

DISCUSSION

Moderate-to-severe malnutrition during infancy is associated with a significantly elevated incidence of impaired IQ in adulthood, even when physical growth is completely rehabilitated. An episode of malnutrition during the first year of life carries risk for significant lifelong functional morbidity.

Gender, socioeconomic and ethnic/racial disparities in cardiovascular disease: a time for change

Cardiovascular disease (CVD) mortality rates have declined steadily over the past few decades but gender, socioeconomic and ethnic/racial disparities have not. These disparities impede cardiovascular health care reaching all those in need. The origins of disparities in CVD are numerous and wide-ranging, having largely evolved from inequalities in society. Similarly, disparities in CVD, interventions and outcomes will also vary depending on the minority or disadvantaged group. For this reason, strategies aimed at reducing such disparities must be stratified according to the target group, while keeping in mind that these groups are not mutually exclusive. There is a pressing need to move beyond what can be inferred from traditional cardiovascular risk factor profiling toward implementation of interventions designed to address the needs of these populations that will eventuate in a reduction of disparities in morbidity and mortality from CVD. This will require targeted and sustainable actions. Only by ensuring timely and equitable access to care for all through increased awareness and active participation can we start to close the gap and deliver appropriate, acceptable and just care to all, regardless of gender, socioeconomic status or ethnicity/race.

Maternal educational level and preschool children's consumption of high-calorie snacks and sugar-containing beverages: mediation by the family food environment

OBJECTIVE

To examine the associations between maternal educational level and preschoolers' consumption of high-calorie snacks and sugar-containing beverages, and to assess the mediating effects of variables relating to the family food environment.

METHODS

We analyzed data from 2814 native Dutch preschoolers enrolled in a birth cohort study in Rotterdam (the Netherlands), between 2002 and 2006. Logistic regression models were used to calculate odds ratios of snacking ≥ 2 times/day and consuming sugar-containing beverages ≥ 3 glasses/day for children of mothers with low, mid-low, and mid-high educational levels (reference group: high educational level), before and after adjustment for mediators.

RESULTS

Children of low and mid-low educated mothers were significantly more likely to consume excessive amounts of high-calorie snacks and sugar-containing beverages compared with children of high educated mothers, with the highest odds in children of low educated mothers (OR: 2.44; 95% CI: 1.84, 3.23 and OR: 2.46; 95% CI: 1.87, 3.24 respectively). Parental feeding practices, parental consumption of sugar-containing beverages, and children's television time partly explained these associations.

CONCLUSION

Maternal educational level is inversely related to preschoolers' consumption of high-calorie snacks and sugar-containing beverages. Targeting the family food environment may be an effective way of reducing educational inequalities in children's unhealthy dietary behaviors.

Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand

OBJECTIVES

Childhood sexual abuse (CSA) has been associated with many adverse medical, psychological, behavioral and socioeconomic outcomes in adulthood. This study aims to examine the linkages between CSA and a wide range of developmental outcomes over a protracted time period to age 30.

METHODS

Data from over 900 members of the New Zealand birth cohort the Christchurch Health and Development Study were examined. CSA prior to age 16 was assessed at ages 18 and 21 years, in addition to: mental health, psychological wellbeing, sexual risk-taking behaviors, physical health and socioeconomic outcomes to age 30.

RESULTS

After statistical adjustment for confounding by 10 covariates spanning socio-demographic, family functioning and child factors, extent of exposure to CSA was associated with increased rates of (B, SE, p): major depression (0.426, 0.094, <.001); anxiety disorder (0.364, 0.089, <.001); suicidal ideation (0.395, 0.089, <.001); suicide attempt (1.863, 0.403, <.001); alcohol dependence (0.374, 0.118, <.002); and illicit drug dependence (0.425, 0.113, <.001). In addition, at age 30 CSA was associated with higher rates of PTSD symptoms (0.120, 0.051, .017); decreased self-esteem (-0.371, 0.181, .041); and decreased life satisfaction (-0.510, 0.189, .007). Childhood sexual abuse was also associated with decreased age of onset of sexual activity (-0.381, 0.091, <.001), increased number of sexual partners (0.175, 0.035, <.001); increased medical contacts for physical health problems (0.105, 0.023, <.001); and welfare dependence (0.310, 0.099, .002). Effect sizes (Cohen's d) for the significant outcomes from all domains ranged from .14 to .53, while the attributable risks for the mental health outcomes ranged from 5.7% to 16.6%.

CONCLUSIONS

CSA is a traumatic childhood life event in which the negative consequences increase with increasing severity of abuse. CSA adversely influences a number of adult developmental outcomes that span: mental disorders, psychological wellbeing, sexual risk-taking, physical health and socioeconomic wellbeing. While the individual effect sizes for CSA typically range from small to moderate, it is clear that accumulative adverse effects on adult developmental outcomes are substantial.

Longer leukocyte telomere length in Costa Rica's Nicoya Peninsula: a population-based study

Studies in humans suggest that leukocyte telomere length may act as a marker of biological aging. We investigated whether individuals in the Nicoya region of Costa Rica, known for exceptional longevity, had longer telomere length than those in other parts of the country. After controlling for age, age squared, rurality, rainy season and gender, the mean leukocyte telomere length in Nicoya was substantially longer (81 base pairs, p<0.05) than in other areas of Costa Rica, providing evidence of a biological pathway to which this notable longevity may be related. This relationship remains unchanged (79 base pairs, p<0.05) after statistically controlling for nineteen potential biological, dietary and social and demographic mediators. Thus the difference in the mean leukocyte telomere length that characterizes this unique region does not appear to be explainable by traditional behavioral and biological risk factors. More detailed examination of mean leukocyte telomere length by age shows that the regional telomere length difference declines at older ages.

Socio-demographic factors and their impact on the number of resections for patients with recurrent glioblastoma

Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumour. Having a second or subsequent operation at recurrence may be a positive prognostic factor for survival. Recent studies suggest that socio-demographic variables may influence survival, raising the question whether surgical care differs based on these variables. We examined the relationship between selected socio-demographic variables and the number of repeat operations undergone by patients with recurrent GBM. Data from all patients diagnosed with GBM between 2001 and 2011 was obtained from a clinical database maintained across two institutions (one public, one private). The clinical and socio-demographic factors for patients who received one operation were compared to those who had two or more operations, using chi-squared analyses to determine statistical differences between groups. Socioeconomic status was measured using the Index of Relative Socioeconomic Advantage and Disadvantage scores. Of 553 patients, 449 (81%) had one operation and 104 (19%) had ≥2 operations. Patients who had ≥2 operations were significantly younger (median 55 years versus 64 years, p<0.001), less likely to have multifocal (p=0.043) or bilateral (p=0.037) disease and more likely to have initial macroscopic resection (p=0.006), than those who had only one operation. Socioeconomic status did not significantly differ between the groups (p=0.31). Similarly, there was no significant difference between the number of operations in patients from regional versus city residence and public versus private hospital. This is reassuring as it suggests similar surgical management options are available for patients regardless of socio-demographic background.

The Relationship between Smoking, Socioeconomic Status and Grip Strength among Community-dwelling Elderly Men in Korea: Hallym Aging Study

OBJECTIVES

Low grip strength is associated with decline in bone mineral density (BMD) and increased risk of spine fracture among the elderly. Smoking, a major factor determining BMD, is also known to have an indirect effect on bone loss. This study investigated whether smoking is associated with grip strength in the community-dwelling elderly in Korea.

METHODS

This study was an outcome of the second of three waves of the Hallym Aging Study from January to May 2007, a population-based study of Koreans aged 45 years and upwards dwelling in Chuncheon. Its 218 subjects comprised men aged 65 years or over. They were evaluated at a general hospital for socioeconomic status, smoking history, and various clinical measures including grip strength.

RESULTS

Grip strength was higher in non-, ex-, and current smokers (33.7 kg, 30.6 kg, and 29.3 kg, respectively). Current smoking was found to increase the risk of decreased grip strength (adjusted odds ratio [aOR], 4.58; 95% confidence interval [CI],1.31 to 16.04) compared with non-smoking, after adjustment for potential covariates including socioeconomic status. After adjustment for smoking effect, education of fewer than six years and monthly income of fewer than 500,000 Korean won increased the risk of decreased grip strength compared with education of more than six years (aOR, 2.88; 95% CI, 1.08 to 7.66) and monthly income of more than 1,500,000 Korean won (aOR, 2.86; 95% CI, 1.08 to 7.54).

CONCLUSIONS

These results showed that current smoking, low education and low income were independent risk factors for decreased grip strength among elderly men in Korea.

Classification of Interdental Space for Different Quadrants on the Basis of Standardization through Threshold Data and Its Comparison with BMI and Socioeconomic Status

BACKGROUND

A better knowledge about the Interdental space is important since it provides insights on the prevalence of malocclusion. To date, there is conflicting evidence on the impact of body mass index (BMI) and Socioeconomic status (SES) on interdental space. A recent review concluded that a greater understanding is required of the interdental space. Therefore, there is a need for a more comprehensive and rigorous assessments of the interdental space and impacts of BMI and SES.

AIM

BMI and SES can be associated with the interdental spacing in deciduous dentition.

DESIGN

The present cross-sectional study was carried out on 448 children of age group of 3 to 5 years out of which 392 were meeting our criteria. Research assessment questionnaire on demographic data was completed by the parents. Study model cast of 392 children free from malocclusion were analyzed.

RESULTS

A statistically significant association between interdental spacing and BMI category was observed. Comparison of BMI with above threshold interdental space revealed that after an optimum weight there is no effect on interdental space. A significant association between SES and interdental spacing was observed for all the four locations (p < 0.01).

CONCLUSION

Evolved normative value can be taken as a standard and the occlusion and interdental spaces are not two completely separate entities and they are interdependent. How to cite this article: Singh T, Singh R, Singh JP. Classification of Interdental Space for Different Quadrants on the Basis of Standardization through Threshold Data and Its Comparison with BMI and Socioeconomic Status. Int J Clin Pediatr Dent 2013;6(1):16-21.

The relationship among antibiotic consumption, socioeconomic factors and climatic conditions

BACKGROUND

Antibiotic consumption in human populations is one of the factors responsible for the emergence of resistant organisms. It is important to track population-based data on an ongoing basis, and to explore the determinants of regional variation in antibiotic consumption.

METHODS

Population-level data were obtained on all outpatient oral antibiotic prescriptions dispensed within British Columbia (BC) between 1996 and 2007. Prescriptions were expressed as the defined daily dose per 1000 inhabitants. Geographical information systems mapping was used to display the spatial variations of antibiotic consumption in BC. The relationships among antibiotic consumption, socioeconomic factors and climatic conditions were explored using Pearson's correlation and regression modelling.

RESULTS

Overall antibiotic consumption was highest in the northern regions of BC. Higher rates of consumption were associated with a greater proportion of the Aboriginal population, lower levels of education and individuals younger than 15 years of age. An inverse correlation was found between some classes of antibiotics and the following factors: individuals older than 65 years of age, mortality rate, doctor-to-population ratio, household size and higher July temperatures. The adjusted regression analyses indicated that higher antibiotic consumption was associated with a higher proportion of Aboriginals and household income.

CONCLUSION

Different rates of antibiotic consumption exist within BC. The use of antibiotics is correlated with several socioeconomic factors and climatic conditions. It may be useful to consider these factors when designing policies to address antibiotic consumption in the community.

Disparities in colorectal cancer in African-Americans vs Whites: Before and after diagnosis

There are differences between African-American and white patients with colorectal cancer, concerning their characteristics before and after diagnosis. Whites are more likely to adhere to screening guidelines. This is also the case among people with positive family history. Colorectal cancer is more frequent in Blacks. Studies have shown that that since 1985, colon cancer rates have dipped 20% to 25% for Whites, while rates have gone up for African-American men and stayed the same for African-American women. Overall, African-Americans are 38% to 43% more likely to die from colon cancer than are Whites. Furthermore, it seems that there is an African-American predominance in right-sited tumors. African Americans tend to be diagnosed at a later stage, to suffer from better differentiated tumors, and to have worse prognosis when compared with Whites. Moreover, less black patients receive adjuvant chemotherapy for resectable colorectal cancer or radiation therapy for rectal cancer. Caucasians seem to respond better to standard chemotherapy regimens than African-Americans. Concerning toxicity, it appears that patients of African-American descent are more likely to develop 5-FU toxicity than Whites, possibly because of their different dihydropyridine dehydrogenase status. Last but not least, screening surveillance seems to be higher among white than among black long-term colorectal cancer survivors. Socioeconomic and educational status account for most of these differences whereas little evidence exists for a genetic contribution in racial disparity. Understanding the nature of racial differences in colorectal cancer allows tailoring of screening and treatment interventions.

Is familiality associated with downward occupation drift in schizophrenia?

OBJECTIVE

Downward occupational drift has been extensively investigated in schizophrenia. It is known that certain illness related factors, such as severity, affect drift, but the impact of familial factors has not been investigated.

METHODS

Occupation drift was studied among patients with schizophrenia/schizoaffective disorder (SZ/SZA)(n=523) and 130 affected sib pairs (ASPs). Drift was analyzed in relation to familiality as well as demographic and clinical variables. For comparison one proband (one of the affected siblings) from each ASP was selected. Occupation drift was measured in relation to the most responsible job held, and with regard to head of the household (HOH) occupation status.

RESULTS

There was no significant difference between single affected and ASP probands in terms of occupational drift from the most responsible job (drifted 39.2% and 38% respectively) and with regard to HOH's occupation (drifted 88% and 82.8% respectively). A significant part of the sample remained unemployed in both single affected and ASP samples. Thus, there was no significant impact of familiality on these variables. However, marital status, pattern of severity, age at onset, gender were found to be associated with downward occupation drift in single affected probands while the only significant factor in familial probands was pattern of severity of severity when measuring in terms of downward drift from most responsible job.

CONCLUSION

Though there is occupation drift in schizophrenia, there is no detectable impact of familial factors. Employment is associated with severity of delete.