To examine whether the magnitude of improvement in the health status of a population over time is dependent on the previous health status of that population.
A study of infant mortality rates in Canada's 12 provinces and territories between the periods 1961-1965 and 1991-1995, and of infant mortality rates in 133 countries between 1960 and 1995.
Spearman's rank correlations, relative risks, and risk differences to measure the relationship between infant mortality in the 1960s and changes in infant mortality between the 1960s and 1990s.
In Canada, regional rankings based on infant mortality rates in 1961-1965 were strongly correlated (inversely) with rankings based on the percent change in infant mortality between 1961-1965 and 1991-1995 (correlation coefficient = -.85). In contrast, internationally, rankings based on infant mortality rates in 133 countries in 1960 were positively correlated with percent change between 1960 and 1995 (correlation coefficient =.56). Regional differences in infant mortality rates, measured using relative risks, declined in Canada (highest relative risk: 4.2, compared with Ontario in the 1960s; highest relative risk: 2.2, compared with Ontario in the 1990s) but increased globally (highest relative risk: 5.0, compared with industrialized countries in 1960; highest relative risk: 15.1, compared with industrialized countries in 1995).
Canadian regions with higher infant mortality rates in 1961-1965 achieved larger improvements compared with regions with initially lower infant mortality rates. The pattern observed within Canada is unlike the pattern observed internationally.
Empowering participation is relevant to many prevention programs. Yet many attempts at empowerment proceed without any clear understanding of the nature of empowerment or the practical requirements of an empowering process. This paper draws on the extensive program-development research for two Canadian prevention projects for disadvantaged children and families: the Parent Mutual Aid Organizations in Child Welfare Project and the Better Beginnings. Better Futures Prevention Project. The lessons learned in these projects about fostering empowering participation are summarized. The paper emphasizes the necessity to respect the demanding and complex requirements of successful empowering participation as well as the need to balance empowering participation with other priorities in prevention programs and projects.
OBJECTIVE: To analyse the association between the Swedish underprivileged area (UPA) score and the standardized mortality ratio in Swedish municipalities. SETTING: All 284 municipalities in Sweden. DESIGN: The UPA-score was calculated for municipalities using the proportion of persons in the following groups: elderly persons living alone, children under five, persons in one-parent families, unskilled (SEI 1), unemployed, persons living in crowded households, those who have moved house in the last year, and persons of minority ethnic origin. After transformation (arc sin square root of) and standardization, each of the eight variables was weighted by the UK general practitioners' average weighting and added to give a composite index of socioeconomic deprivation--the UPA-score. The strength of the relationship between the UPA-score and premature mortality in Sweden was investigated by regression analysis using SMR, for people aged 20-64 years, 1989-93, as the dependent variable. RESULTS: The mean UPA-score (standard deviation) of the 284 municipalities was 0 (10.0) and the range -43 to 28. The mean SMR for all persons was 1 and the range 0.46 to 1.81. The association between UPA-score and SMR was statistically significant and the UPA-score explained 20% of the variation between municipalities in SMR. CONCLUSION: The range of social deprivation at the municipality level in Sweden, as measured by a composite index such as the UPA score, is wide. A two-fold variation at municipality level was also found in premature mortality. There was a significant association between high rates of mortality and social deprivation.
In a current prospective sociomedical study of families in a Stockholm suburb, their home environments were investigated through interviews with the mothers on their first visit to a maternity health centre when pregnant, and through data obtained from various records. In a sample of 498 mothers, 109 women with psychosocial difficulties were compared with 255 women of the same age but who were not psychosocially deprived. While taking into account biomedical risk factors and parity, it appeared that there was little difference between the groups with regard to frequency of complications in pregnancy, delivery or in the newborn infant. The existence of supportive medical and social factors could be one explanation as to why anticipated differences between the groups were not observed.
Bedwetting is the most common urologic complaint among children. Wetting frequency at age 7 years varies from 5% to 15%. Treatment has been multimodal: drugs to depress bladder activity, increase urethral resistance, or modulate sleep; electrophysiologic treatment; and, recently, urine production modulation. All of these approaches reflect a lack of sufficient knowledge of the underlying pathophysiology of nocturnal enuresis. Over the last 13 years, enuresis studies at the Institute of Experimental Clinical Research, the University of Aarhus, Denmark, have focused on sleep disturbances, bladder reservoir function, urine output, and a combination of the three. Sleep studies indicate that: enuretic patients are normal sleepers; the voiding characteristics of an enuretic episode are similar to those of voluntary voiding during the day; and enuresis can take place during any stage of sleep, but generally occurs when the bladder is filled to the equivalent of maximal daytime functional capacity. Bladder reservoir capacity appears to be normal and bladder instability an unimportant factor in the pathology of nocturnal enuresis. However, enuretic patients have been shown to lack the normal nocturnal increase in antidiuretic hormone levels and had nocturnal urine production up to four times the volume of functional bladder capacity, which explains the need for bladder emptying. These findings open new avenues to the approach to treatment based on antidiuretic therapy.
Many studies carried out in first language contexts tend to demonstrate the positive effects of activity programmes aimed at (1) developing metaphonological abilities and (2) developing language skills through active story listening on learning to read and to spell by first-grade students.
This study seeks to extend previous findings by (a) including children, the majority of whom have French as a second language, who attend plurilingual schools and have not been included in previous studies, and (b) providing training based on three essential principles shared by the two kinds of programmes: integrating activities into realistic literacy practice contexts; encouraging active student participation through tasks which very often require problem solving; and tackling, one after the other, different kinds of operations or strategies.
Three groups of students were created out a pool of 202 children enrolled in nine first-grade classes in three underprivileged pluri-ethnic schools. The control group was composed of 46 students who received typical, first-grade methods for teaching reading and spelling. Experimental group 1 (DMPA), 91 students, received a training programme aimed at metaphonological abilities development. Experimental group 2 (DLS), 65 students, received a training intended to develop language skills through active story listening and production.
The students from the three groups were evaluated at the beginning (metaphonological task I, pre-reading task) and at the end (metaphonological task II, word recognition task, text comprehension task, word spelling task) of their first year in elementary school.
The programme for the development of metaphonological abilities enabled DMPA group students to obtain significantly higher scores than the control group on metaphonological task II and word recognition task. The DMPA group children also did significantly better than the control and the DLS groups on the word spelling task. However, the DLS group, who benefited from language skills development activities, also progressed in that they obtained significantly better results than the control group in the word recognition task. Moreover, at the end of grade one, there was no difference in the scores obtained by the groups on a comprehension questionnaire administered after the reading of the narrative text.
The word reading skills of first-grade children in underprivileged pluriethnic settings can be improved through activities aimed at metaphonological abilities development or language skills development by means of active story listening and production. On the other hand, in order to develop word spelling abilities, the development of metaphonological abilities was more effective. Lastly, further research should seek to improve understanding of the absence of effects of either learning programme on narrative text comprehension.
In this study, qualitative and quantitative approaches were combined to study the mechanisms involved in turning-point experiences among individuals who had been exposed to several risk factors in childhood and adolescence. The study was part of the Jyväskylä Longitudinal Study of Personality and Social Development, in which the lives of the participants (196 boys and 173 girls) have been followed from age 8 to age 36. The data concerning turning points was collected by semi-structured interview when the participants were 36 years old. Participants were classified into six developmental trajectories according to risk factors at ages 8-14 and problems of social functioning at age 36. The results showed that individuals with an unsuccessful childhood constructed their life courses less often in terms of education, work and social transitions compared to others. Those who were managing well in their lives at age 36, despite several risk factors in childhood (resilients) reported positive experiences and plenty of choice in relation to their turning points. Participants in the vulnerable subgroup, for their part, perceived turning points more negatively, and reported few opportunities for personal choice. Altogether, the results indicate that childhood experiences influence the content of turning points in adult life by shaping the direction of actual life paths. The quality of current life, however, has a greater bearing on the way turning points are evaluated.