In the present study, pure-tone audiometry was used in 687 Finnish school children, aged 6-15 years, to determine the prevalence of a 6 kHz acoustic dip and related factors among three age groups. Trained audiometricians tested air conduction thresholds in a sound-proof room. A total of 57 children (8.3%) had a clear-cut dip of at least 20 dB at 6 kHz. This dip was more pronounced in older children and in boys. A thorough case history was obtained by questionnaire, with logistic regression analysis showing that low birth weight (
OBJECTIVES: To investigate mortality among users of hostels for homeless people in Copenhagen, and to identify predictors of death such as conditions during upbringing, mental illness, and misuse of alcohol and drugs. DESIGN: Register based follow up study. SETTING: Two hostels for homeless people in Copenhagen, Denmark PARTICIPANTS: 579 people who stayed in one hostel in Copenhagen in 1991, and a representative sample of 185 people who stayed in the original hostel and one other in Copenhagen. MAIN OUTCOME MEASURE: Cause specific mortality. RESULTS: The age and sex standardised mortality ratio for both sexes was 3.8 (95% confidence interval 3.5 to 4.1); 2.8 (2.6 to 3.1) for men and 5.6 (4.3 to 6.9) for women. The age and sex standardised mortality ratio for suicide for both sexes was 6.0 (3.9 to 8.1), for death from natural causes 2.6 (2.3 to 2.9), for unintentional injuries 14.6 (11.4 to 17.8), and for unknown cause of death 62.9 (52.7 to 73.2). Mortality was comparatively higher in the younger age groups. It was also significantly higher among homeless people who had stayed in a hostel more than once and stayed fewer than 11 days, compared with the rest of the study group. Risk factors for early death were premature death of the father and misuse of alcohol and sedatives. CONCLUSION: Homeless people staying in hostels, particularly young women, are more likely to die early than the general population. Other predictors of early death include adverse experiences in childhood, such as death of the father, and misuse of alcohol and sedatives.
Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013.
All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of =14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends.
Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs.
A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.
Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures.
The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, T(vitals), and presenting complaint, T(complaint). The more urgent of the two determines the final triage category, T(final). We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures.
The covariates, T(vitals), T(complaint) and T(final) were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO(2)), respiratory rate (RR), systolic blood pressure (BP) and Glasgow Coma Score (GCS). Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5%) and 'altered level of consciousness' (10.6%). More than half of the patients had a T(complaint) more urgent than T(vitals), the opposite was true in just 6% of the patients.
The HAPT system is valid in terms of predicting in-hospital mortality and ICU admission in the adult acute population. Abnormal vital signs are strongly associated with adverse outcome, while including the presenting complaint in the triage model may result in over-triage.
American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, P.O. Box 6508, Mailstop F800, Aurora, Colorado 80045, USA. email@example.com
OBJECTIVE: Anthropologists with an interest in American Indian alcohol use have long held that how native people drink has been conditioned by aspects of the social organization of their societies prior to the disruptive influences of European colonialism. Our goal in this article was to explicitly test the importance of these factors in four contemporary American Indian cultural groups. METHOD: Using data on adolescent alcohol use drawn from the first full wave of the longitudinal Voices of Indian Teens Project (N = 1,651, 51% female), we tested whether patterns of quantity-frequency of alcohol use and the negative consequences of alcohol use predicted by social organzational variables were found among contemporary adolescents and, subsequently, whether these differences persisted when other, more proximal, variables were included. RESULTS: Cultural differences appeared to account for a small percentage of the variance in both quantity-frequency of alcohol use and negative consequences in the initial steps of our analyses, but the pattern in these data was not consistent with the predictions of existing theories regarding aboriginal social organization. Moreover, these cultural differences were no longer significant in the final step of our analyses, suggesting that the cultural differences that did exist were better explained by other factors, at least among these adolescents. CONCLUSIONS: Although these analyses did not indicate that culture was irrelevant in understanding adolescent alcohol use in American Indian communities, classic formulations of these effects were of limited utility in understanding the experiences of contemporary American Indian adolescents.
Successful academic performance during adolescence is a key predictor of lifetime achievement, including occupational and social success. The present study investigated the important transition from primary to secondary schooling during early adolescence, when academic performance among youth often declines. The goal of the study was to understand how risk factors, specifically lower family resources and male gender, threaten academic success following this "critical transition" in schooling. The study involved a longitudinal examination of the predictors of academic performance in grades 7-8 among 127 (56 % girls) French-speaking Quebec (Canada) adolescents from lower-income backgrounds. As hypothesized based on transition theory, hierarchical regression analyses showed that supportive parenting and specific academic, social and behavioral competencies (including spelling ability, social skills, and lower levels of attention problems) predicted success across this transition among at-risk youth. Multiple-mediation procedures demonstrated that the set of compensatory factors fully mediated the negative impact of lower family resources on academic success in grades 7-8. Unique mediators (social skills, spelling ability, supportive parenting) also were identified. In addition, the "gender gap" in performance across the transition could be attributed statistically to differences between boys and girls in specific competencies observed prior to the transition, as well as differential parenting (i.e., support from mother) towards girls and boys. The present results contribute to our understanding of the processes by which established risk factors, such as low family income and gender impact development and academic performance during early adolescence. These "transitional" processes and subsequent academic performance may have consequences across adolescence and beyond, with an impact on lifetime patterns of achievement and occupational success.
Attitudes concerning the acceptability of suicide have been emphasized as being important for understanding why levels of suicide mortality vary in different societies across the world. While Russian suicide mortality levels are among the highest in the world, not much is known about attitudes to suicide in Russia. This study aims to obtain a greater understanding about the levels and correlates of suicide acceptance in Russia.
Data from a survey of 1,190 Muscovites were analysed using logistic regression techniques. Suicide acceptance was examined among respondents in relation to social, economic and demographic factors as well as in relation to attitudes towards other moral questions.
The majority of interviewees (80%) expressed condemnatory attitudes towards suicide, although men were slightly less condemning. The young, the higher educated, and the non-religious were more accepting of suicide (OR > 2). However, the two first-mentioned effects disappeared when controlling for tolerance, while a positive effect of lower education on suicide acceptance appeared. When controlling for other independent variables, no significant effects were found on suicide attitudes by gender, one's current family situation, or by health-related or economic problems.
The most important determinants of the respondents' attitudes towards suicide were their tolerance regarding other moral questions and their religiosity. More tolerant views, in general, also seemed to explain the more accepting views towards suicide among the young and the higher educated. Differences in suicide attitudes between the sexes seemed to be dependent on differences in other factors rather than on gender per se. Suicide attitudes also seemed to be more affected by one's earlier experiences in terms of upbringing and socialization than by events and processes later in life.
Previous research has found that current smokers are less likely to have access to the Internet than nonsmokers. As access to the Internet continues to expand, does this finding remain true? Also, how many smokers are interested in Web-assisted tobacco interventions (WATIs)? These questions are important to determine the potential role that WATIs might play in promoting tobacco cessation.
The aims of the study were to determine whether smokers are less likely than nonsmokers to have access to the Internet and to establish the level of interest in WATIs among a representative sample of smokers.
A random digit dialing telephone survey was conducted of 8467 adult respondents, 18 years and older, in Ontario, Canada from September 2006 to August 2007. All respondents were asked their smoking status and whether they used the Internet (at home or work in the past 12 months; where; how often in the past 12 months). To assess the level of interest in WATIs, current daily smokers were asked whether they would be interested in a confidential program that they could access on the Internet, free of charge, that would allow them to check their smoking and compare it to other Canadians.
Smokers were marginally less likely to have used the Internet than nonsmokers (74% vs 81% in the last year), and, of those who had access to the Internet, smokers used the Internet less often than nonsmokers. Overall, 40% of smokers said they would be interested in a WATI. The number of cigarettes smoked per day was unrelated to level of interest in the WATI, but time to first cigarette after waking was. Smokers who used the Internet were more interested in the WATI than smokers who did not use the Internet (46% vs 20%).
While the difference in level of Internet use between smokers and nonsmokers was greatly reduced compared to 2002 and 2004 data, smokers still remain marginally less likely to use the Internet than nonsmokers. Overall, there was a substantial level of interest in the WATI among smokers, in particular among smokers who currently use the Internet. These results indicate that WATIs have a substantial potential audience among smokers, and, given the growing body of evidence regarding their efficacy, there is growing support that WATIs have a significant role to play in promoting tobacco cessation.
The paper concerns the accuracy of two dental methods of age estimation based on the radiographic appearance of the root of the lower third molar. The first dental method tested was traditional with a subjective assessment of the root development stage and the second was a new method with a metric measurement of formed root length. Since previous studies have shown a relatively low precision for dentally based age estimation methods during adolescence, an additional independent indicator of chronological age was employed, namely skeletal maturity according to the atlas and method of Greulich and Pyle (Radiographic Atlas of Skeletal Development of the Hand and Wrist Stanford University Press, CA, 1959). The material was Swedish adolescents aged 12-19 years. It was found that all methods gave an overestimation of chronological age, with the highest overestimation, more than 1 year, for the two dental methods. A stepwise multiple regression analysis indicated that skeletal age alone explains 48% of the variation in estimated chronological age. It may be concluded that the accuracy of age estimations based on the lower third molars is quite uncertain during adolescence. Up to 18 years, it is preferable to use skeletal age alone as a predictor. Only a small increase in the explanation coefficient of age variation (3-4%) could be seen if digitized or subjectively estimated root lengths were added as predictors to the skeletal estimation.