The impact of primary care physicians on follow-up care of underserved breast cancer survivors

PURPOSE

To investigate the impact of the involvement of primary care physicians (PCPs) on the receipt of preventive follow-up care after a breast cancer (BC) diagnosis among a low-income population.

METHODS

Multiple logistic regression analyses were performed to identify potential factors associated with receipt of preventive care among 579 low-income women with BC. The main outcome variables at 36 months after BC diagnosis were receipt of annual mammography, Papanicolaou smear in the past 2 years, and ever had colonoscopy for those who were at least 50 years old. The main independent variable was type of provider visit in the past 12 months.

RESULTS

Women with a PCP visit only or both PCP and surgeon/cancer specialist visits in the past 12 months were more likely to have had annual mammography (adjusted odds ratio [AOR], 2.67; P = .109 and AOR, 2.20, P = .0008, respectively), a Papanicolaou smear in the past 2 years (AOR, 2.90; P = .04 and AOR, 2.24, P = .009, respectively), and colonoscopy (AOR, 2.99; P = .041 and AOR, 2.17; P = .026, respectively) than those who only visited surgeons/cancer specialists. Indeed, women who saw only a PCP for their follow-up care had the highest odds ratio of receiving each clinical care service.

CONCLUSIONS

The involvement of PCPs in the medical care of low-income BC survivors results in better preventive follow-up care. Getting PCPs involved in the care of cancer survivors might be particularly pertinent for low-income populations because of lower costs and ease of access compared with cancer specialist-provided care.

[The demographic structure and fertility levels of the population in the new and old slum areas of a "gecekondu" settlement in Antalya Province center]

"The demographic structure and fertility level of the population in two slum areas [in Turkey's Antalya Province]...were investigated with a cross-sectional study in 1989. It was found that the distribution of population by age groups differed and especially the fertility measurements were high in the new area in relation to various social and demographic characteristics. In order to facilitate and accelerate the transition period of slum communities, it is necessary to provide health education, mother and child health and family planning services." (SUMMARY IN ENG)

Drug utilization and nutrition patterns among children from indigent and emigrant families in Crete, Greece

AIM

To examine pharmaceutical needs, prescribed drugs, knowledge about pharmacotherapy and dietary patterns among indigent children.

PATIENTS

101 children (< or =18 y old), typically poor, from low-income families and emigrants coming back home from other countries, registered under Social Care in Chania, Crete. The control group comprised 81 Social Security insured children (< or =18 y old). The length of the study was from January 1995 to December 1997.

RESULTS

The socio-demographic profile of the Social Care children reveals a no schooling rate of 9.7% vs 0% of the control group. The most common disease diagnosed in the indigent children was bronchitis (18.5%) compared with respiratory infection (14.6%) in the control group. Tuberculosis was diagnosed in 2.0% of the Social Care indigent children and in none of the insured children. The most frequently prescribed drug category in both groups as Defined Daily Doses (D.D.D.) was for the respiratory system (32.4% vs 21.2%), while antibiotics were the most expensive (41.6% in the indigent vs 54.9% in the control group). Only 27.4% of Social Care indigent patients, versus 51.2% of insured patients, understood the instructions regarding the proper use of their drugs. Regarding the dietary patterns, significant differences were found in the consumption of breakfast every day (73.7% vs 87.7%), red meat > or =4 per week (0% vs 6.3%) and fruits often (60.1% vs 75.0%).

CONCLUSION

The present study emphasises the need for more information on drug use and the necessity for a continuing health educational intervention among indigent children.

Diphtheria in urban slums in north India

We recorded a reappearance of cases of microbiologically confirmed diphtheria in a tertiary care hospital in north India. Poor immunisation coverage, population migrations, and overcrowded urban slums may be contributory factors.

Eradication of poliomyelitis in countries affected by conflict

The global initiative to eradicate poliomyelitis is focusing on a small number of countries in Africa (Angola, Democratic Republic of the Congo, Liberia, Sierra Leone, Somalia, Sudan) and Asia (Afghanistan, Tajikistan), where progress has been hindered by armed conflict. In these countries the disintegration of health systems and difficulties of access are major obstacles to the immunization and surveillance strategies necessary for polio eradication. In such circumstances, eradication requires special endeavours, such as the negotiation of ceasefires and truces and the winning of increased direct involvement by communities. Transmission of poliovirus was interrupted during conflicts in Cambodia, Colombia, El Salvador, Peru, the Philippines, and Sri Lanka. Efforts to achieve eradication in areas of conflict have led to extra health benefits: equity in access to immunization, brought about because every child has to be reached; the revitalization and strengthening of routine immunization services through additional externally provided resources; and the establishment of disease surveillance systems. The goal of polio eradication by the end of 2000 remains attainable if supplementary immunization and surveillance can be accelerated in countries affected by conflict.

The impact of maternal schooling and occupation on child-rearing attitudes and behaviours in low income neighbourhoods in Cairo, Egypt

As a developing country, Egypt and especially Cairo, is in a transitional phase between a traditional and a modern, education-based society and between traditional child-rearing values of passivity and obedience and new demands for academic competence. Education is seen by present day parents as the major vehicle for the future success and happiness of children and much effort is expended toward this goal. Thirty Cairene mothers from low income neighbourhoods with similar housing standards and crowding, but with different levels of education and occupational status were interviewed (1994-95) about socialisation values and practices and observed with their children in order to evaluate how mothers prepare preschoolers for the cognitive demands of school. It was anticipated that educated working mothers would be less traditional and engage their children in more active competence training (mediation of learning experience, MLE, and authoritative child-raising style, AC-R) as a mediator to children’s cognitive competence. These expectations were supported.

The 30 mothers were generally found to emphasise a controlling, restricting, and protecting style of child rearing, with moral education, compliance, agreeableness, passivity, and loyalty as ideals. Observation revealed little verbal interaction or stimulation of children. Educated working mothers, however, expressed belief in earlier developmental timetables and endorsed the less traditional values of stimulating and interacting rather than controlling and expecting obedience of the child more than the remaining mothers. Educated working mothers were also more positively verbally interacting with their children during the interview than nonworking low-educated mothers. They scored higher on AC-R and on the MLE categories guiding and expanding in interactive play and these variables were related to the children’s cognitive competence (intelligence scores), also when the mothers’ intelligence was accounted for. Mothers’ educational and occupational levels did not predict children’s cognitive competence directly, suggesting that mothers’ child-rearing behaviours acted as mediators. Fathers’ educational level was not related to the children’s cognitive competence. The results point to the potential benefit of investing in girls’ (and future mothers’) education for the future of their children.

The burden of disease among the global poor

BACKGROUND

Global and regional estimates show that non-communicable diseases in old age are rising in importance relative to other causes of ill health as populations age, and as progress continues against communicable diseases among infants and children. However, these estimates, which cover population groups at all income levels, do not accurately reflect conditions that prevail among the poor. We estimated the burden of disease among the 20% of the global population living in countries with the lowest per capita incomes, compared with the 20% of the world's people living in the richest countries.

METHODS

Estimates for the global poorest and richest 20% were prepared for 1990 for deaths and disability-adjusted life years (DALYs), by a procedure used in a prominent recent study of the global disease burden. Projected mortality rates in the year 2020 were established for the world's poorest and richest 20% under various assumptions about the future rate of decline in communicable and non-communicable diseases.

FINDINGS

In 1990, communicable diseases caused 59% of death and disability among the world's poorest 20%. Among the world's richest 20%, on the other hand, non-communicable diseases caused 85% of death and disability. A raised baseline rate of communicable disease decline between 1990 and 2020 would increase life-expectancy among the world's poorest 20% around ten times as much as it would the richest 20% (4.1 vs 0.4 years). However, the poorest 20% would gain only around a quarter to a third as much as the richest 20% from a similar increase in non-communicable diseases (1.4 vs 5.3 years). As a result, a faster decline in communicable diseases would decease the poor-rich gap in 2020, but under an accelerated rate of overall decline in non-communicable diseases, the poor-rich gap would widen.

INTERPRETATION

Our estimates are crude, but despite their limitations, they give a more accurate picture of changes in attributable mortality among the world's poor than do the global averages in current use.