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Sociodemographic
Kinds of Sociodemographic Terms modified by Sociodemographic Selected AbstractsIndicators of pretreatment suicidal ideation in adults with major depressive disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010D. W. Morris Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective:, In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method:, This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results:, Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion:, Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI. [source] Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlatesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009A. O. Adewuya Objective:, Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Method:, Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results:, Overall, 21 patients (21.2%) were categorised as having ,good' and 36 (36.4%) as having ,poor' subjective QOL. ,Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93,11.48), comorbid medical problems (OR 4.75, 95% CI 1.43,16.33), unemployment (OR 3.75, 95% CI 1.25,11.72) and poor social support (OR 4.60, 95% CI 1.49,14.28). Conclusion:, Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment. [source] Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer SurgeryHEALTH SERVICES RESEARCH, Issue 6p2 2003Gary L. Ellison Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients. Data Sources. We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data. Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance. Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes. Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70,0.81). Conclusions. Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance. [source] Clinical and phenomenological comparisons of delusional and non-delusional major depression in the Chinese elderlyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2003Tien-Wen Lee Abstract Objective Distinct clinical entities, with and without delusions, have been reported for depressed patients. This study explores the clinical and phenomenological aspects of delusional and non-delusional major depression in elderly Chinese patients. Methods A total of 156 depressed patients (105 males and 51 females) admitted to our geriatric psychiatry ward were investigated. Sociodemographic and clinical characteristics were compared between patients divided into two groups,according to presence or absence of delusions. Results On admission, higher risk of suicide attempt, higher chance of guilt feelings, and greater daily functional impairment were observed for the deluded group. Further, the score of Hamilton Depression Rating Scale was higher and the score of Mini-Mental State Examination was lower for delusional depressives. Conclusion Our findings were grossly concordant with previous Western reports, and highlight the importance of identifying the delusional subgroup of depressive patients because of the higher risk of suicide attempt. Copyright © 2003 John Wiley & Sons, Ltd. [source] Persecutory symptoms and perceptual disturbance in a community sample of older people: the Islington studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2001G. Livingston Abstract Background While there are extensive studies of paranoid symptoms and perceptual disturbance (PPD) in younger adults, relatively little is known about older adults with similar symptoms. Method This study took place in Islington, an inner London borough. Enumeration Districts were randomised to provide a sampling frame. Residents aged 65 or over were interviewed at home. The Short-CARE was used to elicit psychiatric symptoms and diagnosis. Sociodemographic particulars were elicited using the Client Sociodemographic and Service Receipt Inventory. Questions were asked regarding sight and hearing. We used subsections of the geriatric mental scale to identify people who had PPD symptoms. Medications taken were recorded. We asked ,Do you have any health problems?' as a screening question for subjective health problems. Results We interviewed 720 people. Twenty-eight (3.9%) participants scored positively on the PPD sub-scales of the GMS. A forward logistic regression analysis for independent predictors of PPD found the significant independent predictors were dementia (p,=,0.0000; odds ratio 6.8), drinking alcohol in last 6 months (p,<,0.03; odds ratio 0.3), drinking alcohol to help sleep (p,<,0.005; odds ratio 9.6), subjective memory loss (p,<,0.007; odds ratio 3.3) and uncorrected visual impairment (p,<,0.02; odds ratio 2.8). Conclusion There is a relatively high prevalence of PPD in older people living in the community. This is not associated with higher use of services despite the increased needs. Further studies should consider interventions to meet this unmet need. Copyright © 2001 John Wiley & Sons, Ltd [source] Characteristics of 32 SupercentenariansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006Emily A. Schoenhofen BA OBJECTIVES: To report phenotypic characteristics of 32 age-validated supercentenarians. DESIGN: Case series. SETTING: U.S.-based recruitment effort. PARTICIPANTS: Thirty-two supercentenarians. MEASUREMENTS: Multiple forms of proof were used to validate age claims. Sociodemographic, activities of daily living, and medical history data were collected. RESULTS: Age range was 110 to 119. Fifty-nine percent had Barthel Index scores in the partially to totally dependent range, whereas 41% required minimal assistance or were independent. Few subjects had a history of clinically evident vascular-related diseases, including myocardial infarction (n=2, 6%) and stroke (n=4, 13%). Twenty-two percent (n=7) were taking medications for hypertension. Twenty-five percent (n=8) had a history of cancer (all cured). Diabetes mellitus (n=1, 3%) and Parkinson's disease (n=1, 3%) were rare. Osteoporosis (n=14, 44%) and cataract history (n=28, 88%) were common. CONCLUSION: Data collected thus far suggest that supercentenarians markedly delay and even escape clinical expression of vascular disease toward the end of their exceptionally long lives. A surprisingly substantial proportion of these individuals were still functionally independent or required minimal assistance. [source] Prevalence and Severity of Dental Caries in Adolescents Aged 12 and 15 Living in Communities with Various Fluoride ConcentrationsJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2007América Patricia Pontigo-Loyola DrO Abstract Objectives: To determine the experience, prevalence, and severity of dental caries in adolescents naturally exposed to various fluoride concentrations. Methods: A cross-sectional census was conducted on 1,538 adolescents aged 12 and 15 years living at high altitude above sea level (>2,000 m or >6,560 ft) in above-optimal fluoridated communities (levels ranging from 1.38 to 3.07 ppm) of Hidalgo, Mexico. Sociodemographic and socioeconomic data were collected using questionnaires. Two previously trained and standardized examiners performed the dental exams. Results: Caries prevalence was 48.6 percent and mean of decay, missing, and filling teeth (DMFT) for the whole population was 1.15 ± 1.17. In terms of severity, 9.6 percent of the adolescents had DMFT , 4, and 1.7 percent had ,7. The significant caries index (SiC) was 2.41 in the group of 12-year-olds, and 3.46 in the 15-year-olds. Higher experience and prevalence were observed in girls, in children with dental visit in the past year, those in the wealthiest socioeconomic status (SES) (quartiles 2, 3, and 4), those whose locale of residence is in San Marcos and Tula Centro, and in fluorosis-free children and those with moderate/severe fluorosis. In an analysis of caries severity (DMFT , 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. Conclusions: The results indicated that caries experience, prevalence, and severity as well as SiC index among 12- and 15-year-old adolescents were relatively low. Sociodemographic and socioeconomic variables commonly associated with dental caries were also observed in Mexican adolescents. Unlike other studies, we found that caries increased with higher SES. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT , 4) in these high-altitude communities. [source] Sociodemographic and Health Profiles of the Oldest Old In ChinaPOPULATION AND DEVELOPMENT REVIEW, Issue 2 2002Zeng Yi Unique data from a 1998 healthy longevity baseline survey provide demographic, socio-economic, and health characteristics of the oldest old, aged 80,105, in China. This subpopu-lation is growing rapidly and is likely to need extensive social and health services. A large majority of Chinese oldest old live with their children and rely mainly on children for financial support and care. Most Chinese oldest old had no or very little education. Ability to function independently in daily living declines rapidly and self-rated health declines moderately across the oldest old ages. As compared to their urban counterparts, the rural oldest old have far less pension support, are significantly less educated, and are more likely to be widowed and to rely on children for support. Apart from higher rates of survival, the female oldest old in China are far more disadvantaged than the male oldest old. [source] Sociodemographic and clinical factors associated with relapse in schizophreniaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2007GOBIND CHABUNGBAM md Abstract The aim of the present study was to examine sociodemographic and clinical factors associated with relapse in schizophrenia. The study group consisted of a convenience sample of 40 schizophrenia patients (20 patients each in relapse and remission). Relapse and remission were defined based on clinical criteria (ICD-10 criteria, course since last episode, and duration of remission) and psychometric criteria (scores on Socio-Occupational Functioning Assessment Scale [SOFAS] and Positive and Negative Syndrome Scale for Schizophrenia [PANSS]). The index group was evaluated after the occurrence of current relapse but within 6 months of its onset. Sociodemographic, current psychopathology (PANSS) and functioning (SOFAS), and other (mainly retrospective) variables were assessed with a specifically designed clinical profile sheet, Schedule for Affective Disorders and Schizophrenia Lifetime version, Presumptive Stressful life Events Scale, and World Health Organization Life Chart Schedule for Assessment of Course and Outcome of Schizophrenia. Patients who had relapsed were more symptomatic and exhibited greater dysfunction in comparison to remitted patients. Relapse in schizophrenia was significantly associated with unemployment, number of psychotic episodes, side-effects of medication, and life events score. The present findings suggest that a severe illness (no. psychotic episodes, unemployment), psychological stress and inappropriate treatment (side-effects of medicines) may be causally related to relapse in schizophrenia. However, the possibility that these variables may be caused by relapse or may be explained by a common underlying variable needs to be assessed prospectively. [source] Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Health and Development StudyCOMMUNITY DENTISTRY AND ORAL EPIDEMIOLOGY, Issue 6 2000W. Murray Thomson Abstract ,Objectives: To test a modification of a previously-reported six-item dental neglect scale and examine its association with dental health and service-use among young adults. Methods: Of the 980 26-year-old participants in the Dunedin Multidisciplinary Health and Development Study, 973 completed the scale and 930 underwent dental examination. Sociodemographic and dental service-use data were collected using a self-report questionnaire. Results: Factor analysis showed that five of the original six items loaded on the scale, and responses to those items were summed to give a dental neglect scale score for each participant. Scale scores were normally distributed (mean=13.0; SD=3.6; range 5 to 25), and a median split created higher and lower dental neglect groups. A higher proportion of the higher neglect group group: (i) were male; (ii) rated their dental health and dental appearance as below average; (iii) brushed their teeth infrequently; (iv) had extensive plaque deposits; (v) used dental services only when they had a problem; (vi) had not recently seen a dentist; (vii) had lost at least one permanent tooth because of caries, and (viii) had a greater number of decayed tooth surfaces. Conclusions: Although further examination of its validity and reliability is indicated, the dental neglect scale appears to hold promise for use in dental health promotion, not only in highlighting population groups or individuals who would benefit from intensive health promotion efforts, but also in the evaluation of health promotion interventions. [source] Relating psychiatric disorders, offender and offence characteristics in a sample of adolescent sex offenders and non-sex offendersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2007A.Ph. Van Wijk Introduction,Several studies have paid attention to the relationship between psychiatric disorders and adolescent offending but few have distinguished different types of offenders, especially within the category of youngsters who have committed sex offences. Aim,To test for relationships between psychiatric disorder and specific offence category among young male offenders. Method,Nationwide data were extracted from Dutch Forensic Psychiatric Services (FPD) files for five groups of offenders, as defined by their index offence: 308 violent sex offenders; 134 non-violent sex-offenders; 270 sex offenders against children; 3148 violent offenders and 1620 offenders charged with any crime other than interpersonal body contact crimes. They were compared on individual characteristics and psychiatric diagnoses according to DSM-IV criteria. Having a diagnosis of a paraphilia alone was exclusively associated with sex offending, therefore all such youths were excluded from further analyses. The OVERALS technique was used to explore possible relationships between offence, psychiatric diagnoses, sociodemographic and individual characteristics among the remaining young men for whom all pertinent data were available (n = 1894). Results,Sex offenders constituted a distinct group of juvenile delinquents. Developmental disorders were more common among non-violent sex offenders and child molesters. Violent offences were more typical of delinquents from immigrant backgrounds. Conclusion,Group differences in types of psychiatric diagnoses may reflect differences in aetiological factors for the various types of sexual and other delinquent behaviour, and this would be worthy of further study. Copyright © 2007 John Wiley & Sons, Ltd. [source] Depression, hopelessness and suicide ideation among vulnerable prisonersCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2005Emma J. Palmer PhD Background Self-harm among prisoners is high, and suicide rates increasing. Assessment of depressive characteristics is easy. To what extent are these linked with previous self-harm? Aims To compare depressive characteristics of prisoners who report previous self-harm with those who do not. Methods Twenty-four new arrivals at an adult male category B local prison who reported previous episodes of suicidal behaviour (including self-harm and/or explicit attempted suicide) were assessed using the Beck Hopelessness Scale, the Beck Depression Inventory-II, and the Beck Scale for Suicide Ideation. A further 24 new arrivals were matched as closely as possible with them on sociodemographic and offending characteristics. Results Mean scores on the Beck Hopelessness Scale, the Beck Depression Inventory-II, and the Beck Scale for Suicide Ideation were significantly higher among the prisoners with a history of self-harm. Discussion Prisoners with a previous history of self-harm are more likely than those without to show a range of depressive symptoms than their imprisoned peers without such a history, suggesting a continued vulnerability to self-harm and perhaps suicide. Copyright © 2005 John Wiley & Sons, Ltd. [source] Identifying target groups for the prevention of anxiety disorders in the general populationACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010N. M. Batelaan Batelaan NM, Smit F, de Graaf R, van Balkom AJLM, Vollebergh WAM, Beekman ATF. Identifying target groups for the prevention of anxiety disorders in the general population. Objective:, To avert the public health consequences of anxiety disorders, prevention of their onset and recurrence is necessary. Recent studies have shown that prevention is effective. To maximize the health gain and minimize the effort, preventive strategies should focus on high-risk groups. Method:, Using data from a large prospective national survey, high-risk groups were selected for i) the prevention of first ever (n = 4437) and ii) either first-ever or recurrent incident anxiety disorders (n = 4886). Indices used were: exposure rate, odds ratio, population attributable fraction and number needed to be treated. Risk indicators included sociodemographic, psychological and illness-related factors. Results:, Recognition of a few patient characteristics enables efficient identification of high-risk groups: (subthreshold) panic attacks; an affective disorder; a history of depressed mood; a prior anxiety disorder; chronic somatic illnesses and low mastery. Conclusion:, Preventive efforts should be undertaken in the selected high-risk groups. [source] Indicators of pretreatment suicidal ideation in adults with major depressive disorderACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2010D. W. Morris Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective:, In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method:, This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results:, Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion:, Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI. [source] Achieving symptomatic remission in out-patients with schizophrenia , a naturalistic study with quetiapineACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009T. Wobrock Objective:, Symptomatic remission was defined as a score of mild or less on each of eight key schizophrenia symptoms on the Positive and Negative Syndrome Scale (PANSS-8). To evaluate the symptomatic remission criterion in clinical practice and to determine predictors for achieving symptomatic remission, a 12-week non-interventional study (NIS) with quetiapine was conducted in Germany. Method:, For the comparison of patients with and without symptomatic remission, sociodemographic and clinical variables of 693 patients were analyzed by logistic regression for their predictive value to achieve remission. Results:, Four hundred and four patients (58.3%) achieved symptomatic remission after 12 weeks' treatment with quetiapine. Remission was significantly predicted by a low degree of PANSS-8 total score, PANSS single items blunted affect (N1), social withdrawal (N4), lack of spontaneity (N6), mannerism and posturing (G5), and low disease severity (CGI-S) at baseline. Predictors of non-remission were older age, diagnosis of schizophrenic residuum, multiple previous episodes, longer duration of current episode, presence of concomitant diseases, and alcohol abuse. Conclusion:, This study demonstrated that the majority of schizophrenia out-patients achieved symptomatic remission after 12 weeks treatment and confirms the importance of managing negative symptoms in order to achieve disease remission. [source] Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlatesACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009A. O. Adewuya Objective:, Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one's particular belief system. This study aimed to examine the subjective QOL of Nigerian out-patients with schizophrenia and its correlates. Method:, Out-patients with Schizophrenia (n = 99) completed the WHOQOL-BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results:, Overall, 21 patients (21.2%) were categorised as having ,good' and 36 (36.4%) as having ,poor' subjective QOL. ,Poor' subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93,11.48), comorbid medical problems (OR 4.75, 95% CI 1.43,16.33), unemployment (OR 3.75, 95% CI 1.25,11.72) and poor social support (OR 4.60, 95% CI 1.49,14.28). Conclusion:, Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi-centred studies are needed to adequately identify factors predicting QOL in this environment. [source] Higher fasting insulin but lower fasting C-peptide levels in African Americans in the US population,DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2002Maureen I. Harris Abstract Background Fasting serum insulin and fasting serum C-peptide are risk factors for developing type 2 diabetes. Because of the higher incidence of type 2 diabetes in African Americans and Hispanic Americans, it is likely that these groups may differ from non-Hispanic whites in their levels of insulin and C-peptide. Methods We analyzed data from a nationally representative sample of adults in the US population for whom sociodemographic, clinical, and laboratory information were obtained. The data were used to describe distributions of fasting insulin and fasting C-peptide in non-Hispanic white, non-Hispanic black, and Mexican American men and women aged ,20 years without a medical history of diabetes. Results Among men, Mexican Americans had higher insulin values than non-Hispanic whites and blacks. Among women, both Mexican Americans and blacks had higher insulin values than whites. For C-peptide, differences by sex and race-ethnicity paralleled those seen for fasting insulin with the exception that black men had significantly lower C-peptide values than whites and Mexican Americans. After adjustment for age, fasting plasma glucose (FPG), body mass index (BMI), and waist-to-hip ratio (WHR), the higher levels for insulin in blacks and Mexican Americans remained; both black men and women had significantly lower C-peptide values than whites and Mexican Americans. The molar ratio of fasting C-peptide to fasting insulin was similar for men and women in each race-ethnic group. However, blacks had substantially lower ratios than whites and Mexican Americans. Conclusions We found wide variations in fasting insulin and fasting C-peptide levels by race and ethnicity in US adults that were not explained by confounding factors, primarily measures of obesity. Most notably, the higher fasting insulin and lower fasting C-peptide levels in blacks implies that there is a derangement in insulin clearance and an impairment in beta-cell function in blacks compared with whites and Mexican Americans. Published in 2002 by John Wiley & Sons, Ltd. [source] Comparison of four groups of substance-abusing in-patients with different psychiatric comorbidityACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2001J. Hättenschwiler Objective: ,Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in-patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder. Method: ,Apart from sociodemographic, therapy-related variables and a detailed survey of their substance use, all subjects were assessed with BPRS and SCL-90-R. Results: ,No differences were found in the patients' demography, psychosocial adjustment and substance consumption career. Significant differences were found in regard to some therapy variables reflecting adherence to treatment and global outcome and to the level of psychopathology. Conclusion: ,Both substance use and comorbid psychiatric disorder have a variable impact on distinct areas of patients' general condition and functioning. The group with comorbid affective disorder appeared to be the most difficult to treat and the therapeutic approach to this disorder deserves reconsideration. [source] To what extent does frontal type executive impairment affect coping strategies in Parkinson's disease?EUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2008S. Montel Background and purpose:, Given the frequency of executive dysfunction in Parkinson's disease (PD), we wonder to what extent this fact might influence the coping strategies which are used. Methods:, A total of 135 PD patients with no dementia were divided into two groups according to their cognitive status (,with frontal type executive impairment' or ,without frontal type executive executive impairment'). All patients were seen for a semi-structured interview to collect sociodemographic and clinical information and to assess their cognitive and mental states (DSM-IV-TR, frontal assessment battery and Montgomery and Asberg Depression Rating Scale). Then, all patients completed two self-report questionnaires concerning their coping strategies (Ways of Coping Checklist and Coping with Health, Injuries and Problems Scale). Results:, After controlling the depression, we noticed a significant effect of cognitive status on positive re-evaluation (P = 0.02). Interestingly, except for instrumental strategies, patients with frontal type executive impairment used significantly more coping strategies than did patients without frontal type executive impairment. Conclusion:, Our results suggest that neither executive impairment nor depression prevents patients from using coping strategies extensively. [source] Urban Form and Household Activity-Travel BehaviorGROWTH AND CHANGE, Issue 2 2006RON N. BULIUNG ABSTRACT Cities and metropolitan regions face several challenges including urban sprawl, auto dependence and congestion, and related environmental and human health effects. Examining the spatial characteristics of daily household activity-travel behavior holds important implications for understanding and addressing urban transportation issues. Research of this sort can inform development of urban land use policy that encourages the use of local opportunities, potentially leading to reduced motorized travel. This article examines the potential household activity-travel response to a planned metropolitan polycentric hierarchy of activity centers. Behavioral observations have been drawn from an activity-travel survey conducted in the Portland, Oregon, metropolitan area during the mid-1990s. Evidence presented from exploratory analysis indicates an urban/suburban differential, with less daily travel and smaller activity spaces for urban households. Investigation of the travel reduction potential of the proposed land-use strategy suggests that location effects could be offset by adjustments to household sociodemographic and mobility characteristics. [source] Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemHEALTH SERVICES RESEARCH, Issue 1 2010Dorothy Thornton Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Data Source. Linked California hospital discharge (2000,2001), birth, fetal death, and county mental health system (CMHS) records. Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Results. Compared with deliveries in the general non,mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention. [source] Effects of Poverty and Lack of Insurance on Perceptions of Racial and Ethnic Bias in Health CareHEALTH SERVICES RESEARCH, Issue 3 2008Irena Stepanikova Objective. To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care. Data Source. 2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556). Study Design. We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups. Principal Findings. Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician,patient communication is negatively associated with perceived racial and ethnic bias. Conclusions. Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups. [source] The Effects of Geography and Spatial Behavior on Health Care Utilization among the Residents of a Rural RegionHEALTH SERVICES RESEARCH, Issue 1 2005Thomas A. Arcury Objective. This analysis determines the importance of geography and spatial behavior as predisposing and enabling factors in rural health care utilization, controlling for demographic, social, cultural, and health status factors. Data Sources. A survey of 1,059 adults in 12 rural Appalachian North Carolina counties. Study Design. This cross-sectional study used a three-stage sampling design stratified by county and ethnicity. Preliminary analysis of health services utilization compared weighted proportions of number of health care visits in the previous 12 months for regular check-up care, chronic care, and acute care across geographic, sociodemographic, cultural, and health variables. Multivariable logistic models identified independent correlates of health services utilization. Data Collection Methods. Respondents answered standard survey questions. They located places in which they engaged health related and normal day-to-day activities; these data were entered into a geographic information system for analysis. Principal Findings. Several geographic and spatial behavior factors, including having a driver's license, use of provided rides, and distance for regular care, were significantly related to health care utilization for regular check-up and chronic care in the bivariate analysis. In the multivariate model, having a driver's license and distance for regular care remained significant, as did several predisposing (age, gender, ethnicity), enabling (household income), and need (physical and mental health measures, number of conditions). Geographic measures, as predisposing and enabling factors, were related to regular check-up and chronic care, but not to acute care visits. Conclusions. These results show the importance of geographic and spatial behavior factors in rural health care utilization. They also indicate continuing inequity in rural health care utilization that must be addressed in public policy. [source] Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer SurgeryHEALTH SERVICES RESEARCH, Issue 6p2 2003Gary L. Ellison Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients. Data Sources. We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data. Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance. Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes. Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70,0.81). Conclusions. Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance. [source] Elevated prevalence of hepatitis C infection in users of United States veterans medical centers,HEPATOLOGY, Issue 1 2005Jason A. Dominitz Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti,hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1,288 of 3,863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of anti,hepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans. (HEPATOLOGY 2005;41:88,96.) [source] Approaches to career success: An exploration of surreptitious career-success strategiesHUMAN RESOURCE MANAGEMENT, Issue 1 2006Lloyd C. Harris Theorists have forwarded a vast range of career-success determinants, including sociodemographic, social capital, personality, and other behavioral factors. We suggest that existing studies have overconcentrated on the overt behavioral determinants of career success to the detriment of the covert, clandestine, and concealed. Our analysis of two detailed qualitative case studies involving 112 indepth interviews with executives, managers, supervisors, and front-line staff in a large financial services organization and a medium-sized fashionable restaurant group uncovered five main strategies of surreptitious career success. These strategies are obligation creation and exploitation, personal-status enhancement, information acquisition and control, similarity exploitation, and proactive vertical alignment. Our findings indicate that just over 79% of those interviewed (88 of 112) referred to, at some point in their careers, premeditated strategies to enhance their careers that they concealed from coworkers. Consequently, we argue that surreptitious actions are central to employee career-focused activities and fundamental to a more complete understanding of the complexities of career-oriented employee behavior. © 2006 Wiley Periodicals, Inc. [source] Infant Symbolic Play as an Early Indicator of Fetal Alcohol-Related DeficitINFANCY, Issue 6 2010Christopher D. Molteno Infant symbolic play was examined in relation to prenatal alcohol exposure and socioenvironmental background and to predict which infants met criteria for fetal alcohol syndrome (FAS) at 5 years. A total of 107 Cape-Colored, South African infants born to heavy drinking mothers and abstainers/light drinkers were recruited prenatally. Complexity of play, sociodemographic and psychological correlates of maternal alcohol use, and quality of parenting were assessed at 13 months, and intelligence quotient and FAS diagnosis at 5 years. The effect of drinking on spontaneous play was not significant after control for social environment. In contrast, prenatal alcohol and quality of parenting related independently to elicited play. Elicited play predicted 5-year Digit Span and was poorer in infants subsequently diagnosed with FAS/partial FAS and in nonsyndromal heavily exposed infants, compared with abstainers/light drinkers. Thus, symbolic play may provide an early indicator of risk for alcohol-related deficits. The independent effects of prenatal alcohol and quality of parenting suggest that infants whose symbolic play is adversely affected by alcohol exposure may benefit from stimulation from a responsive caregiver. [source] Factors associated with suicidal behaviors in a large French sample of inpatients with eating disordersINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 7 2007Valérie J. Fedorowicz MDCM Abstract Objective: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. Method: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. Results: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. Conclusion: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007 [source] Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusionINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 6 2005Ann Callaghan RN RM BNurs(Hons) Executive summary Objective, To critically review all literature related to pacifier use for full-term healthy infants and young children. The specific review questions addressed are: What is the evidence of adverse and/or positive outcomes of pacifier use in infancy and childhood in relation to each of the following subtopics: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Inclusion criteria, Specific criteria were used to determine which studies would be included in the review: (i) the types of participants; (ii) the types of research design; and (iii) the types of outcome measures. To be included a study has to meet all criteria. Types of participants,The participants included in the review were healthy term infants and healthy children up to the age of 16 years. Studies that focused on preterm infants, and infants and young children with serious illness or congenital malformations were excluded. However, some total population studies did include these children. Types of research design, It became evident early in the review process that very few randomised controlled trials had been conducted. A decision was made to include observational epidemiological designs, specifically prospective cohort studies and, in the case of sudden infant death syndrome research, case,control studies. Purely descriptive and cross-sectional studies were excluded, as were qualitative studies and all other forms of evidence. A number of criteria have been proposed to establish causation in the scientific and medical literature. These key criteria were applied in the review process and are described as follows: (i) consistency and unbiasedness of findings; (ii) strength of association; (iii) temporal sequence; (iv) dose,response relationship; (v) specificity; (vi) coherence with biological background and previous knowledge; (vii) biological plausibility; and (viii) experimental evidence. Studies that did not meet the requirement of appropriate temporal sequencing of events and studies that did not present an estimate of the strength of association were not included in the final review. Types of outcome measures,Our specific interest was pacifier use related to: ,breast-feeding; ,sudden infant death syndrome; ,infection; ,dental malocclusion. Studies that examined pacifier use related to procedural pain relief were excluded. Studies that examined the relationship between pacifier use and gastro-oesophageal reflux were also excluded as this information has been recently presented as a systematic review. Search strategy, The review comprised published and unpublished research literature. The search was restricted to reports published in English, Spanish and German. The time period covered research published from January 1960 to October 2003. A protocol developed by New Zealand Health Technology Assessment was used to guide the search process. The search comprised bibliographic databases, citation searching, other evidence-based and guidelines sites, government documents, books and reports, professional websites, national associations, hand search, contacting national/international experts and general internet searching. Assessment of quality, All studies identified during the database search were assessed for relevance to the review based on the information provided in the title, abstract and descriptor/MeSH terms, and a full report was retrieved for all studies that met the inclusion criteria. Studies identified from reference list searches were assessed for relevance based on the study title. Keywords included: dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care. Initially, studies were reviewed for inclusion by pairs of principal investigators. Authorship of articles was not concealed from the reviewers. Next, the methodological quality of included articles was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All 20 studies that were accepted met minimum set criteria, but few passed without some methodological concern. Data extraction, To meet the requirements of the Joanna Briggs Institute, reasons for acceptance and non-acceptance at each phase were clearly documented. An assessment protocol and report form was developed for each of the three phases of review. The first form was created to record investigators' evaluations of studies included in the initial review. Those studies that failed to meet strict inclusion criteria were excluded at this point. A second form was designed to facilitate an in-depth critique of epidemiological study methodology. The checklist was pilot tested and adjustments were made before reviewers were trained in its use. When reviewers could not agree on an assessment, it was passed to additional reviewers and discussed until a consensus was reached. At this stage, studies other than cohort, case,control and randomised controlled trials were excluded. Issues of clarification were also addressed at this point. The final phase was that of integration. This phase, undertaken by the principal investigators, was assisted by the production of data extraction tables. Through a process of trial and error, a framework was formulated that adequately summarised the key elements of the studies. This information was tabulated under the following headings: authors/setting, design, exposure/outcome, confounders controlled, analysis and main findings. Results, With regard to the breast-feeding outcome, 10 studies met the inclusion criteria, comprising two randomised controlled trials and eight cohort studies. The research was conducted between 1995 and 2003 in a wide variety of settings involving research participants from diverse socioeconomic and cultural backgrounds. Information regarding exposure and outcome status, and potential confounding factors was obtained from: antenatal and postnatal records; interviews before discharge from obstetric/midwifery care; post-discharge interviews; and post-discharge postal and telephone surveys. Both the level of contact and the frequency of contact with the informant, the child's mother, differed widely. Pacifier use was defined and measured inconsistently, possibly because few studies were initiated expressly to investigate its relationship with breast-feeding. Completeness of follow-up was addressed, but missing data were not uniformly identified and explained. When comparisons were made between participants and non-participants there was some evidence of differential loss and a bias towards families in higher socioeconomic groups. Multivariate analysis was undertaken in the majority of studies, with some including a large number of sociodemographic, obstetric and infant covariates and others including just maternal age and education. As might be expected given the inconsistency of definition and measurement, the relationship between pacifier use and breast-feeding was expressed in many different ways and a meta-analysis was not appropriate. In summary, only one study did not report a negative association between pacifier use and breast-feeding duration or exclusivity. Results indicate an increase in risk for a reduced overall duration of breast-feeding from 20% to almost threefold. The data suggest that very infrequent use may not have any overall negative impact on breast-feeding outcomes. Six sudden infant death syndrome case,control studies met the criteria for inclusion. The research was conducted with information gathered between 1984 and 1999 in Norway, UK, New Zealand, the Netherlands and USA. Exposure information was obtained from a variety of sources including: hospital and antenatal records, death scene investigation, and interview and questionnaire. Information for cases was sought within 2 days after death, within 2,4 weeks after death and in one study between 3 and 11 years after death. Information for controls was sought from as early as 4 days of a nominated sudden infant death syndrome case, to between 1 and 7 weeks from the case date, and again in one study some 3,11 years later. In the majority of the studies case ascertainment was determined by post-mortem. Pacifier use was again defined and measured somewhat inconsistently. All studies controlled for confounding factors by matching and/or using multivariate analysis. Generally, antenatal and postnatal factors, as well as infant care practices, and maternal, family and socioeconomic issues were considered. All five studies reporting multivariate results found significantly fewer sudden infant death syndrome cases used a pacifier compared with controls. That is, pacifier use was associated with a reduced incidence of sudden infant death syndrome. These results indicate that the risk of sudden infant death syndrome for infants who did not use a pacifier in the last or reference sleep was at least twice, and possibly five times, that of infants who did use a pacifier. Three studies reported a moderately sized positive association between pacifier use and a variety of infections. Conversely, one study found no positive association between pacifier use at 15 months of age and a range of infections experienced between the ages of 6 and 18 months. Given the limited number of studies available and the variability of results, no meaningful conclusions could be drawn. Five cohort studies and one case,control study focused on the relationship between pacifier use and dental malocclusion. Not one of these studies reported a measure of association, such as an estimate of relative risk. It was therefore not possible to include these studies in the final review. Implications for practice, It is intended that this review be used as the basis of a ,best practice guideline', to make health professionals aware of the research evidence concerning these health and developmental consequences of pacifier use, because parents need clear information on which they can base child care decisions. With regard to the association between pacifier use and infection and dental malocclusion it was found that, due to the paucity of epidemiological studies, no meaningful conclusion can be drawn. There is clearly a need for more epidemiological research with regard to these two outcomes. The evidence for a relationship between pacifier use and sudden infant death syndrome is consistent, while the exact mechanism of the effect is not well understood. As to breast-feeding, research evidence shows that pacifier use in infancy is associated with a shorter duration and non-exclusivity. It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven. Because breast-feeding confers an important advantage on all children and the incidence of sudden infant death syndrome is very low, it is recommended that health professionals generally advise parents against pacifier use, while taking into account individual circumstances. [source] Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, BrazilINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2009Edson Shiguemi Hirata Abstract Objectives To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. Methods A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment. Results Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, ,mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. Conclusions The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries. Copyright © 2009 John Wiley & Sons, Ltd. 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