1
|
The Lasting Health Impact of Early-Life Chronic Poverty: Evidence from Starvation Experiences in Rural China. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-021-09694-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
2
|
Lee YS, Oh JY, Min KH, Lee SY, Kang KH, Shim JJ. The association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:427-437. [PMID: 30962986 DOI: 10.21037/jtd.2019.01.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Because poverty is a multifaceted concept with a complex definition, this concept may not be useful when formulating economic policy. Thus, most governments use the relative poverty line to identify poor participants who may receive economic support. The aim of this study was to investigate the association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease (COPD). Methods We retrospectively analyzed data from 3,223 individuals included in South Korea. Living below the poverty line was defined as receiving a monthly income less than the minimum cost of living. Results Of the 3,223 participants included in this analysis, 832 (25.8%) met the definition of living below the relative poverty line and 384 (11.9%) had COPD. Of the 3,223 participants, 161 of the 832 (19.4%) living below the poverty line and 223 of the 2,391 (9.3%) living above the poverty line had COPD. In our study, participants living below the poverty line had a 1.4-time higher risk of COPD development compared with those living above the poverty line (OR =1.4; P=0.012). Elderly people living below the poverty line were 1.5-time more likely to be at risk of COPD development than those living above the poverty line (OR =1.5; P=0.021). Conclusions People living below the relative poverty line have an increased prevalence of COPD, especially older people with COPD. From the perspective of COPD disease control, policy makers should consider providing national economic support for the early detection and management of COPD in people living below the relative poverty line.
Collapse
Affiliation(s)
- Young Seok Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Hoon Min
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Sung Yong Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Kyung Ho Kang
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| | - Jae Jeong Shim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Korea
| |
Collapse
|
3
|
Strouse C, Gomulka J. Capsule commentary on Peterson et al., Financial exploitation of older adults: a population based prevalence study. J Gen Intern Med 2014; 29:1688. [PMID: 25155637 PMCID: PMC4242869 DOI: 10.1007/s11606-014-2953-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chris Strouse
- Medical College of Wisconsin, Milwaukee, WI, 53226, USA,
| | | |
Collapse
|
4
|
Intention to Re-enter the Labour Force among Older Male Singaporeans: Does Health Status Matter? JOURNAL OF POPULATION AGEING 2014. [DOI: 10.1007/s12062-014-9105-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
|
6
|
Kimmel PL, Fwu CW, Eggers PW. Segregation, income disparities, and survival in hemodialysis patients. J Am Soc Nephrol 2013; 24:293-301. [PMID: 23334394 DOI: 10.1681/asn.2012070659] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Social and ecologic factors, such as residential segregation, are determinants of health in the general population, but how these factors associate with outcomes among patients with ESRD is not well understood. Here, we examined associations of income inequality and residence, as social determinants of health, with survival among black and white patients with ESRD. We merged U.S. Renal Data System data from 589,036 patients who started hemodialysis from 2000 through 2008 with race-specific median household income data from the Census Bureau. We used Gini Index coefficients to assess income distributional inequality and the Dissimilarity Index to determine residential segregation. Black patients lived in areas of lower median household income compared with white patients ($26,742 versus $41,922; P<0.001). Residence in areas with higher median household income was associated with improved survival. Among whites, income inequality was associated with mortality. Among blacks exclusively, residence in highly segregated areas was associated with increased mortality. In conclusion, black hemodialysis patients in the United States are particularly susceptible to gradients in income and residential segregation. Interventions directed at highly segregated black neighborhoods might favorably affect hemodialysis patient outcomes.
Collapse
Affiliation(s)
- Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5458, USA.
| | | | | |
Collapse
|
7
|
Young ME, Razack S, Hanson MD, Slade S, Varpio L, Dore KL, McKnight D. Calling for a broader conceptualization of diversity: surface and deep diversity in four Canadian medical schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:1501-10. [PMID: 23018335 DOI: 10.1097/acm.0b013e31826daf74] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Policy groups recommend monitoring and supporting more diversity among medical students and the medical workforce. In Canada, few data are available regarding the diversity of medical students, which poses challenges for policy development and evaluation. The authors examine diversity through a framework of surface (visible) and deep (less visible) dimensions and present data regarding a sample of Canadian medical students. METHOD Between 2009 and 2011, nine cohorts from four Canadian medical schools completed the Health Professions Student Diversity Survey (HPSDS) either on paper or online. Items asked each participant's age, gender, gender identity, sexual identity, marital status, ethnicity, rural status, parental income, and disability. Data were analyzed descriptively and compared, when available, with national data. RESULTS Of 1,892 students invited, 1,552 (82.0%) completed the HPSDS. Students tended to be 21 to 25 years old (68.3%; 1,048/1,534), female (59.0%; 902/1,529), heterosexual (94.6%; 1,422/1,503), single (90.1%; 1,369/1,520), and unlikely to report any disability (96.5%; 1,463/1,516). The majority of students identified with the gender on their birth certificate (99.8%; 1,512/1,515). About half had spent the majority of their lives in urban environments (46.7%; 711/1,521), and most reported parental household incomes of over $100,000/year (57.6%; 791/1,373). Overall, they were overrepresentative of higher-income groups and underrepresentative of populations of Aboriginal, black, or Filipino ethnicities in Canada. CONCLUSIONS The authors propose the development of a National Student Diversity Database to support both locally relevant policies regarding pipeline programs and an examination of current application and selection procedures to identify potential barriers for underrepresented students.
Collapse
Affiliation(s)
- Meredith E Young
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | | | | | | | | | | | | |
Collapse
|
8
|
Vaucher P, Bischoff T, Diserens EA, Herzig L, Meystre-Agustoni G, Panese F, Favrat B, Sass C, Bodenmann P. Detecting and measuring deprivation in primary care: development, reliability and validity of a self-reported questionnaire: the DiPCare-Q. BMJ Open 2012; 2:e000692. [PMID: 22307103 PMCID: PMC3274718 DOI: 10.1136/bmjopen-2011-000692] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Advances in biopsychosocial science have underlined the importance of taking social history and life course perspective into consideration in primary care. For both clinical and research purposes, this study aims to develop and validate a standardised instrument measuring both material and social deprivation at an individual level. METHODS We identified relevant potential questions regarding deprivation using a systematic review, structured interviews, focus group interviews and a think-aloud approach. Item response theory analysis was then used to reduce the length of the 38-item questionnaire and derive the deprivation in primary care questionnaire (DiPCare-Q) index using data obtained from a random sample of 200 patients during their planned visits to an ambulatory general internal medicine clinic. Patients completed the questionnaire a second time over the phone 3 days later to enable us to assess reliability. Content validity of the DiPCare-Q was then assessed by 17 general practitioners. Psychometric properties and validity of the final instrument were investigated in a second set of patients. The DiPCare-Q was administered to a random sample of 1898 patients attending one of 47 different private primary care practices in western Switzerland along with questions on subjective social status, education, source of income, welfare status and subjective poverty. RESULTS Deprivation was defined in three distinct dimensions: material (eight items), social (five items) and health deprivation (three items). Item consistency was high in both the derivation (Kuder-Richardson Formula 20 (KR20) =0.827) and the validation set (KR20 =0.778). The DiPCare-Q index was reliable (interclass correlation coefficients=0.847) and was correlated to subjective social status (r(s)=-0.539). CONCLUSION The DiPCare-Q is a rapid, reliable and validated instrument that may prove useful for measuring both material and social deprivation in primary care.
Collapse
Affiliation(s)
- Paul Vaucher
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Thomas Bischoff
- Institute of General Medicine, University of Lausanne, Lausanne, Switzerland
| | - Esther-Amélie Diserens
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Lilli Herzig
- Institute of General Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Francesco Panese
- Institute of History of Medicine, University of Lausanne, Lausanne, Switzerland
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Catherine Sass
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé, St-Etienne, France
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
9
|
Ross PT, Williams BC, Doran KM, Lypson ML. First-Year Medical Students’ Perceptions of Physicians’ Responsibilities Toward the Underserved: An Analysis of Reflective Essays. J Natl Med Assoc 2010; 102:761-5. [DOI: 10.1016/s0027-9684(15)30672-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Afifi M. Wealth Index association with gender issues and the reproductive health of Egyptian women. Nurs Health Sci 2009; 11:29-36. [DOI: 10.1111/j.1442-2018.2009.00419.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
11
|
Climate change and public health: thinking, communicating, acting. Am J Prev Med 2008; 35:403-10. [PMID: 18929964 DOI: 10.1016/j.amepre.2008.08.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 06/20/2008] [Accepted: 08/07/2008] [Indexed: 01/13/2023]
|
12
|
Gregg J, Solotaroff R, Amann T, Michael Y, Bowen J. Health and disease in context: a community-based social medicine curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:14-19. [PMID: 18162745 DOI: 10.1097/acm.0b013e31815c67f0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite the increasing attention paid to the role of social forces in determining health, most physicians finish their training ill-prepared to address these issues. The authors describe their efforts to fill that training gap for internal medicine residents at Oregon Health and Science University through a community-based social medicine curriculum, designed in 2006 in conjunction with community partners at Central City Concern (CCC), an organization addressing homelessness, poverty, and addiction in downtown Portland, Oregon. The challenge was to develop a curriculum that would (1) fit within the scheduling constraints of an established categorical internal medicine residency program, (2) give all internal medicine residents a chance to better understand how social forces affect health, and (3) help show how they, as health professionals, might intervene to improve health and health care. The authors maintain that by developing this curriculum with community partners--who took the lead in deciding what residents should learn about their community and how they should learn it--the residency program is providing a relatively brief but extremely rich opportunity for residents to engage the personal, social, and health-related issues experienced by clients served by CCC. The authors first provide a brief overview of the curriculum and describe how the principles and practices of community-based participatory research were used in its development. They then discuss the challenges involved in teaching medical residents about social determinants of health, how their academic-community partnership approaches those challenges, and the recently established methods of evaluating the curriculum.
Collapse
Affiliation(s)
- Jessica Gregg
- Division of General Internal Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA.
| | | | | | | | | |
Collapse
|
13
|
Abstract
Past research has indicated that child abuse is related to mental and physical health conditions and that mental and physical health conditions are related to decreased health-related quality of life (HRQOL). However, little is known about the independent relationship between child abuse and HRQOL. For the current analysis, data were from the nationally representative Netherlands Mental Health Survey and Incidence Study. Multiple linear regression analyses tested the relationships between child abuse and current HRQOL (SF-36) after adjusting for the effects of sociodemographic variables and numerous psychiatric disorders and physical health conditions. Neglect, psychological abuse, physical abuse, severe sexual abuse, and number of types of child abuse experienced were associated with reduced mental HRQOL. Psychological abuse, physical abuse, and number of types of child abuse experienced were associated with reduced physical HRQOL. Child abuse is an important determinant of HRQOL. The ability to successfully reduce the occurrence of child abuse or provide early intervention after child abuse occurs may help to improve HRQOL in the general population.
Collapse
|
14
|
McCartney K, Dearing E, Taylor BA, Bub KL. Quality Child Care Supports the Achievement of Low-Income Children: Direct and Indirect Pathways Through Caregiving and the Home Environment. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2007; 28:411-426. [PMID: 19578561 DOI: 10.1016/j.appdev.2007.06.010] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Existing studies of child care have not been able to determine whether higher quality child care protects children from the effects of poverty, whether poverty and lower quality child care operate as dual risk factors, or whether both are true. The objective of the current study was to test two pathways through which child care may serve as a naturally occurring intervention for low-income children: a direct pathway through child care quality to child outcomes, and an indirect pathway through improvements in the home environment. Children were observed in their homes and child care settings at 6, 15, 24, and 36 months. An interaction between family income-to-needs ratio and child care quality predicted School Readiness, Receptive Language, and Expressive Language, as well as improvements in the home environment. Children from low-income families profited from observed learning supports in the form of sensitive care and stimulation of cognitive development, and their parents profited from unobserved informal and formal parent supports. Policy implications are discussed.
Collapse
|
15
|
Plumb JD, Brawer R. The Social and Behavioral Foundations of Men's Health—A Public Health Perspective. Prim Care 2006; 33:17-34, vii. [PMID: 16516677 DOI: 10.1016/j.pop.2005.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- James D Plumb
- Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Curtis Building, Suite 401, 1015 Walnut Street, Philadelphia, PA 19107, USA.
| | | |
Collapse
|
16
|
Chibnall JT, Tait RC, Andresen EM, Hadler NM. Race and socioeconomic differences in post-settlement outcomes for African American and Caucasian Workers' Compensation claimants with low back injuries. Pain 2005; 114:462-472. [PMID: 15777871 DOI: 10.1016/j.pain.2005.01.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 01/03/2005] [Accepted: 01/18/2005] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to predict post-settlement pain intensity, psychological distress, disability, and financial struggle among African American (n=580) and non-Hispanic Caucasian (n=892) Workers' Compensation claimants with single incident low back injury. The study was a population-based telephone survey conducted in three population centers in Missouri. Post-settlement outcomes were predicted from claimant demographics (race, age, gender); socioeconomic status (SES); diagnosis and legal representation; and Workers' Compensation resolution variables (treatment costs, temporary disability status, disability rating, settlement costs). Simultaneous-entry, hierarchical multiple linear regression analyses indicated that African American race and lower SES predicted higher levels of post-settlement pain intensity, psychological distress (general mental health, pain-related catastrophizing), disability (pain-related role interference), and financial struggle, independent of age, gender, diagnosis, legal representation, and Workers' Compensation resolution variables. The results suggest that African American race and lower SES-relative to Caucasian race and higher SES-are risk factors for poor outcomes after occupational low back injury. Mechanisms to explain these associations are discussed, including patient-level, provider-level, legal, and Workers' Compensation system-level factors.
Collapse
Affiliation(s)
- John T Chibnall
- Department of Psychiatry, Saint Louis University School of Medicine, 1221 S. Grand Blvd. St Louis, MO 63104, USA School of Public Health, Saint Louis University, St Louis, MO, USA Departments of Medicine and Microbiology/Immunology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | |
Collapse
|
17
|
Peterman TA, Lindsey CA, Selik RM. This Place Is Killing Me: A Comparison of Counties Where the Incidence Rates of AIDS Increased the Most and the Least. J Infect Dis 2005; 191 Suppl 1:S123-6. [PMID: 15627222 DOI: 10.1086/425284] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The objective of this study was to identify the socioeconomic and health characteristics of communities with the largest proportional increases in incidence rates of acquired immunodeficiency syndrome (AIDS). METHODS Reported AIDS cases (1981-1990 and 1995-1999) were used for a comparison between 20 US counties with the largest proportional increases in incidence rates of AIDS and 20 US counties with the smallest increases. Data were obtained from Community Health Status Indicators Reports of the Health Resources and Services Administration (HRSA) and from the US Census Bureau. RESULTS Counties with the largest increases in the incidence of AIDS had lower levels of income, education, and literacy; higher incidence rates of syphilis, age-adjusted mortality (all causes), and infant mortality; more low-birth-weight infants; and higher levels on all 9 specific mortality measures in the HRSA reports. CONCLUSIONS The incidence of AIDS increased the most in areas where many other health problems occurred. Research is needed to identify and address the root causes of ill health.
Collapse
Affiliation(s)
- Thomas A Peterman
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | |
Collapse
|
18
|
Li IC. The Effectiveness of a Health Promotion Program for the Low-Income Elderly in Taipei, Taiwan. J Community Health 2004; 29:511-25. [PMID: 15587349 DOI: 10.1007/s10900-004-3398-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study assessed the effectiveness of a health promotion program for low-income elderly provided by trained low-income home health aides. Indicators of the effectiveness of this program included improvement in physical health, psychosocial health and functional status, including activities of daily living (ADL) and instrumental activities of daily living (IADL) as well as changes in perceived health promotion needs. This evaluation study used a single group pre- and post-test experiment design. After informed consent forms were signed by participants, 89 purposively selected low-income elderly (aged 64-96) completed pre-test structured surveys, while 60 participants (aged 68-96) completed post-test surveys. Post-test scores indicated improved nutritional status (paired t = 2.64, p < .05) and chore management of IADL abilities (paired t = 2.83, p < .01). No significant difference in psychosocial status were found between pre- and post-test scores. Perceived needs for health promotion services decreased after the intervention. The results show that the health promotion services were effective in improving health status and decreasing perceived needs for services among low-income elderly in Taipei. Recommendations based on this study for developing services for the low-income elderly must take health promotion intervention into consideration.
Collapse
Affiliation(s)
- I-Chuan Li
- Institute of Community Health Nursing, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
19
|
Christopher Jones R, Pothier CE, Blackstone EH, Lauer MS. Prognostic importance of presenting symptoms in patients undergoing exercise testing for evaluation of known or suspected coronary disease. Am J Med 2004; 117:380-9. [PMID: 15380494 DOI: 10.1016/j.amjmed.2004.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 06/04/2004] [Indexed: 11/16/2022]
Abstract
PURPOSE Chest symptoms, along with standard cardiovascular risk factors, are commonly factored into pretest risk stratification of patients who are referred for stress testing. We sought to determine the independent prognostic value of chest symptoms. METHODS We studied the outcomes of 10,870 patients referred for symptom-limited exercise testing who had no history of myocardial revascularization, heart failure, or arrhythmias. Chest symptoms were prospectively characterized according to prespecified definitions. Propensity analysis was used to account for differences in baseline and exercise characteristics. RESULTS Typical angina was present in 635 patients (6%), atypical angina in 3408 (33%), nonanginal chest pain in 1805 (17%), and dyspnea in 841 (8%). The remaining 4181 patients (38%) were asymptomatic. During a mean follow-up of 4.3 years, there were 381 deaths. After propensity matching patients who had typical angina with asymptomatic patients, symptoms were not predictive of mortality (adjusted hazard ratio [HR] = 0.8; 95% confidence interval [CI]: 0.6 to 1.3; P = 0.4). Among patients who had chest pain, typical angina was associated with a highly significant risk of mortality as compared with nonanginal chest pain (HR = 2.7; 95% CI: 1.4 to 5.1; P = 0.002), but not compared with atypical angina (HR = 1.3; 95% CI: 0.9 to 2.1; P = 0.21). CONCLUSION After accounting for baseline and exercise characteristics, the presence of symptoms was not independently associated with increased mortality among patients undergoing testing for known or suspected coronary disease. Among patients who actually had chest pain, typical angina carried a higher mortality risk.
Collapse
Affiliation(s)
- R Christopher Jones
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Ohio 44195, USA
| | | | | | | |
Collapse
|
20
|
Rocha FL, Guerra HL, Lima-Costa MFF. Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: the Bambuí study. Sleep Med 2003; 3:121-6. [PMID: 14592230 DOI: 10.1016/s1389-9457(01)00119-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Population-based studies of insomnia among adults residing in communities in developing countries are rare. The objectives of this population-based study were to determine the prevalence and factors associated with insomnia among adults (18 years and over) living in a Brazilian town with 15,000 inhabitants (Bambuí MG) and to determine how the use of different definitions of insomnia affect its prevalence. METHODS A total of 87.3% of 1221 randomly selected individuals aged 18+ participated. Prevalences were estimated based on different definitions. To determine the associated characteristics, insomnia was defined as a complaint in the last month, occurring at least three times a week, causing distress. RESULTS (1) Prevalence ranged from 12.0 to 76.3%; (2) prevalence of insomnia, as defined above, was 35.4%; (3) prevalence among women increased with age and was higher than that of men; (4) insomnia was independently associated with less education in both sexes, and among females it was associated with older age (60+ years). CONCLUSIONS The prevalence of insomnia in Bambuí was high, similar to that of urban centers of developed countries; this investigation substantiated the importance of operational criteria in studies of insomnia.
Collapse
Affiliation(s)
- Fábio Lopes Rocha
- Medical Residency of Psychiatry, Institute of Social Security of the Civil Servants of Minas Gerais, Belo Horizonte, Brazil, Rua dos Otoni 106, 30150.270, Belo Horizonte, MG, Brazil.
| | | | | |
Collapse
|
21
|
Wood E, Montaner JSG, Bangsberg DR, Tyndall MW, Strathdee SA, O'Shaughnessy MV, Hogg RS. Expanding access to HIV antiretroviral therapy among marginalized populations in the developed world. AIDS 2003; 17:2419-27. [PMID: 14600512 DOI: 10.1097/00002030-200311210-00003] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Abstract
Socioeconomic status is associated with mortality, yet does not fully explain health disparities. This study analyzed data from the Project on Human Development in Chicago Neighborhoods (PHDCN), in the USA, to identify neighborhood-level factors associated with premature mortality. 1990 US Census data and mortality data from Chicago were merged with data from PHDCN, a study of 8782 residents in 343 Chicago neighborhoods. We performed a multivariate analysis to determine the association between premature mortality and concentrated disadvantage, residential stability, immigrant concentration, "collective efficacy" (a measure of willingness to help out for the common good), and "broken windows" (boarded up stores and homes, litter, and graffiti). Both collective efficacy and broken windows appeared to mediate the effect of concentrated disadvantage on all-cause premature mortality and mortality from cardiovascular disease and homicide, but there was also an interaction between broken windows and collective efficacy. Non-income characteristics associated with poverty should be further investigated. Interventions to determine whether these factors are causally related to health are needed.
Collapse
Affiliation(s)
- Deborah A Cohen
- RAND Corporation, 1700 Main Street, Santa Monica, CA 2138, USA.
| | | | | |
Collapse
|
23
|
Abstract
People in Portugal have never been so healthy. Nevertheless, there are great differences in health status between social groups and regions. In 1994, Portugal was the country with the second worst level of inequality in terms of income distribution and with the highest level of poverty in the European Union (EU). Poverty in Portugal affects mainly the elderly and women (especially in single parent families). Beyond these groups, there are the children, the ethnic minorities and the homeless. Substance abusers, the unemployed, and ex-prisoners are also strongly affected by situations of social exclusion and poverty. Although poverty has been an important issue on the political agenda in Portugal, it shows a worrying tendency to resist traditional Social Security interventions. In the late 1990s, however, welfare coverage rates appear to have risen. To what extent can poverty cause a worsening of health status? Is there any sustainable positive association between welfare and improved health status? How, to whom and when should actions to improve the health status of the disadvantaged be addressed, without subverting the health status of the rest of the population. It is also necessary to reveal the consequences of poor health to individuals, families and communities in terms of income, social empowerment and the ability to fulfil other needs. Finally, reflection on the role and effectiveness of traditional social security models is necessary, in order to improve the impact and adequacy of its interventions. The goal of this paper is to contribute to the knowledge about disadvantage, the current health situation of the most vulnerable groups in Portuguese society-those affected by poverty, deprivation and social exclusion-and to detect the constraints on access to health and health care.
Collapse
Affiliation(s)
- Paula Santana
- Department of Geography, University of Coimbra, Portugal.
| |
Collapse
|
24
|
Doyal L. Moral problems in the use of coercion in dealing with nonadherence in the diagnosis and treatment of tuberculosis. Ann N Y Acad Sci 2001; 953:208-15. [PMID: 11795414 DOI: 10.1111/j.1749-6632.2001.tb11379.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coercion and detainment can be a morally acceptable strategy to fight the spread of tuberculosis, but these measures need to be placed into a much broader context than that of their short-term potential effectiveness. TB should be de-stigmatized by full acknowledgment that we all share the blame for its perpetuation. When coercion and detention are necessary, they should incorporate a strategy of optimum protection for minimum violation of autonomy. National and international health care programs should provide effective and nonthreatening treatments for TB and other related illnesses such as HIV and should develop policies to tackle the environmental causes of TB and provide support for vulnerable victims. Corporate pressures to continue world poverty must be undermined.
Collapse
Affiliation(s)
- L Doyal
- Department of Human Science and Medical Ethics, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary, University of London, UK.
| |
Collapse
|
25
|
Affiliation(s)
- N M Hadler
- Department of Medicine, University of North Carolina at Chapel Hill, 27599-7280, USA
| |
Collapse
|
26
|
Trevena LJ, Nutbeam D, Simpson JM. Asking the right questions of disadvantaged and homeless communities: the role of housing, patterns of illness and reporting behaviours in the measurement of health status. Aust N Z J Public Health 2001; 25:298-304. [PMID: 11529608 DOI: 10.1111/j.1467-842x.2001.tb00583.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the self-reported health status and its relationship to key demographic variables among patrons of a charity-run meals service at The Exodus Foundation, in urban Sydney, Australia. METHOD Random-sample cross-sectional study of 100 face-to-face interviews (79% recruitment rate). Self-reported health status was measured by subjective rating scale, open-ended and checklist questions about presence and type of acute and chronic disease. Anaysis by logistic regression of fair-poor health status on demographic variables in Exodus patrons and genera Sydney population adjusted for age and sex using the 1995 National Health Survey. RESULTS Compared to housed but poor counterparts within the Exodus sample, homeless people were significantly more likely to report fair-poor health status (age-adjusted OR-3.0, 95% CI 1.3-7.1). Exodus patrons, as a whole, were much more likely than Sydney's general population to report fair-poor health status, after adjusting for age and sex (OR-4.5, 95% CI 2.9-7.0) and had a more serious pattern of illness (diseases of the digestive system; depression; common cold; bronchitis; refractive errors; drug and alcohol dependence; diabetes mellitus Type II). Exodus patrons reported fewer acute and chronic illnesses with open-ended questions than with a checklist (p<0.001). CONCLUSION In this population there was a strong relationship between poor health and homelessness. When patterns of illness and injury were measured within this disadvantaged group, they showed more serious illness types than in the general population. Such patterns may not be identified by methods often used in traditional population health surveys.
Collapse
Affiliation(s)
- L J Trevena
- Department of Public Health & Community Medicine, University of Sydney, New South Wales.
| | | | | |
Collapse
|
27
|
Affiliation(s)
- J Balint
- Center for Medical Ethics and Department of Medicine, Albany Medical College, New York 12208, USA.
| |
Collapse
|
28
|
Heath I, Haines A, Jelinek GA. Open invitation from the International Poverty and Health Network to all health professionals. Emerg Med Australas 2000. [DOI: 10.1046/j.1442-2026.2000.00100.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
29
|
Louria DB, Skurnick JH, Palumbo P, Bogden JD, Rohowsky-Kochan C, Denny TN, Kennedy CA. HIV heterosexual transmission: a hypothesis about an additional potential determinant. Int J Infect Dis 2000; 4:110-6. [PMID: 10737850 DOI: 10.1016/s1201-9712(00)90105-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Transmission rates of human immunodeficiency virus (HIV) during heterosexual intercourse vary dramatically around the world. In Asia and South America, they are extraordinarily high, whereas in the United States and Europe, rates are much lower even after a large number of unprotected contacts. The transmission rates in Africa also probably are high, but the available studies unfortunately are weak. In Thailand, female-to-male transmission rates per contact were estimated at.056 (l in 18) compared to.0002 to.0015 (1/5000-1. 5/1000) for male-to-female transmission in the United States and Europe. Male-to-female transmission in Thailand appears to show, as expected, even greater transmission likelihood compared to female-to-male rates. In general, in the United States and Europe, transmission rates within heterosexual couples range from less than 10% to 22%, whereas in Thailand and Brazil, the rates exceed 40%. The much lower transmission rate per contact in the United States and Europe is based on an assumption that HIV transmitters are a homogeneous group. Wiley and colleagues argue that transmitters are likely to be a heterogeneous group with a large percentage of very low frequency transmitters and a small percentage of high frequency transmitters. That hypothesis is given some support by a cluster of cases in rural New York State in which one man appeared to infect 31% of his many contacts.
Collapse
Affiliation(s)
- D B Louria
- Departments of Preventive Medicine and Community Health, New Jersey Medical School, Newark, NJ 07103, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Heath I, Haines A, Glover J, Hetzel D. Open invitation from the International Poverty and Health Network to all healthcare professionals. Med J Aust 2000; 172:356-7. [PMID: 10840482 DOI: 10.5694/j.1326-5377.2000.tb124002.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
31
|
|
32
|
Haines A, Heath I, Smith R. Joining together to combat poverty: everybody welcome and needed. Med Confl Surviv 2000; 16:155-8. [PMID: 10893936 DOI: 10.1080/13623690008409509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
33
|
Haines A, Heath I, Smith R. Joining Together to Combat Poverty. J Palliat Care 2000. [DOI: 10.1177/082585970001600102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andy Haines
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF
| | - Iona Heath
- Intercollegiate Forum on Poverty and Health, Royal College of General Practitioners, London SW7 1PU
| | | |
Collapse
|
34
|
Salsberry PJ, Nickel JT, Polivka BJ, Kuthy RA, Slack C, Shapiro N. Self-reported health status of low-income mothers. IMAGE--THE JOURNAL OF NURSING SCHOLARSHIP 2000; 31:375-80. [PMID: 10628105 DOI: 10.1111/j.1547-5069.1999.tb00523.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the self-reported health status of low-income mothers before major health and welfare policy reform in the state of Ohio, to compare the health status of this group with the general population age-based norms, and to examine differences in health status among insurance and racial subgroups. Policy makers and others have a need for key health-status information about low-income mothers, a topic for which little empirical data currently exist. DESIGN Descriptive using a cross-sectional survey with convenience sampling; 502 women were interviewed at intake sites in four countries in central Ohio, 1995 to 1996. METHODS Health status was measured using the general health status index developed by J. E. Ware and colleagues (1995). Two summary measures, one indicating physical health and one indicating mental health, were used and compared with published norms. Multivariate logistic models were examined for depression and physical health status. FINDINGS A significant level of depression in the population of low-income mothers was found as were differences in physical health scores by insurance group. People insured privately had the highest physical health scores, while those enrolled in fee-for-service Medicaid had scores indicating the poorest health. No significant difference was found between racial groups in self-reported health status. CONCLUSIONS Self-reported mental health status is low among some low-income female populations. Physical health is worse for the Medicaid-enrolled group compared to both uninsured and privately insured groups. This poor state of health will likely diminish the success of welfare reform to improve the economic self-sufficiency of these women unless comprehensive health services are available.
Collapse
Affiliation(s)
- P J Salsberry
- College of Nursing, Ohio State University, Columbus 43210, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Haines A, Heath I, Smith R. Joining together to combat poverty. Everybody welcome and needed. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1-2. [PMID: 10617503 PMCID: PMC1117303 DOI: 10.1136/bmj.320.7226.1] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
36
|
Haines A. Poverty and world health: challenges and opportunities. J Epidemiol Community Health 1999; 53:597-8. [PMID: 10616669 PMCID: PMC1756786 DOI: 10.1136/jech.53.10.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
37
|
Macleod J, Loudon R. Tackling health inequalities in primary care. Exploring possible solutions to a problem is more important than describing the problem. BMJ (CLINICAL RESEARCH ED.) 1999; 319:454; author reply 454-5. [PMID: 10445941 PMCID: PMC1127057 DOI: 10.1136/bmj.319.7207.454a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|