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 (
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.
Geographical access to health care facilities is known to influence health services usage. As societies age, accessibility to health care becomes an increasingly acute public health concern. It is known that seniors tend to have lower mobility levels, and it is possible that this may negatively affect their ability to reach facilities and services. Therefore, it becomes important to examine the mobility situation of seniors vis-a-vis the spatial distribution of health care facilities, to identify areas where accessibility is low and interventions may be required.
Accessibility is implemented using a cumulative opportunities measure. Instead of assuming a fixed bandwidth (i.e. a distance threshold) for measuring accessibility, in this paper the bandwidth is defined using model-based estimates of average trip length. Average trip length is an all-purpose indicator of individual mobility and geographical reach. Adoption of a spatial modelling approach allows us to tailor these estimates of travel behaviour to specific locations and person profiles. Replacing a fixed bandwidth with these estimates permits us to calculate customized location- and person-based accessibility measures that allow inter-personal as well as geographical comparisons.
The case study is Montreal Island. Geo-coded travel behaviour data, specifically average trip length, and relevant traveller's attributes are obtained from the Montreal Household Travel Survey. These data are complemented with information from the Census. Health care facilities, also geo-coded, are extracted from a comprehensive business point database. Health care facilities are selected based on Standard Industrial Classification codes 8011-21 (Medical Doctors and Dentists).
Model-based estimates of average trip length show that travel behaviour varies widely across space. With the exception of seniors in the downtown area, older residents of Montreal Island tend to be significantly less mobile than people of other age cohorts. The combination of average trip length estimates with the spatial distribution of health care facilities indicates that despite being more mobile, suburban residents tend to have lower levels of accessibility compared to central city residents. The effect is more marked for seniors. Furthermore, the results indicate that accessibility calculated using a fixed bandwidth would produce patterns of exposure to health care facilities that would be difficult to achieve for suburban seniors given actual mobility patterns.
The analysis shows large disparities in accessibility between seniors and non-seniors, between urban and suburban seniors, and between vehicle owning and non-owning seniors. This research was concerned with potential accessibility levels. Follow up research could consider the results reported here to select case studies of actual access and usage of health care facilities, and related health outcomes.
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This study examined (1) disparities in the proportion of persons who accessed a physician for treatment of a diagnosed mental disorder across 17 health regions in Alberta, Canada, and (2) the extent to which regional disparities in physician access could be explained by differences in regional demographies, population needs, or physician supply.
The study illustrates the use of ecological comparisons for regional health system performance evaluations. Regional characteristics were aggregated from four sources of data: the health insurance registry file (population denominators and regional demographies), physician claims data (treatment access), census data (social indicators of population need), and the medical directory of the College of Physicians of Surgeons (physician supply).
Regional variability in needs-adjusted measures of access to physician-based treatment services were comparatively small (varying by a factor of 1.6). Models containing adjustments for demography, need, and physician supply explained 41% of regional variation in access. Of the total variation explained, physician supply explained a smaller proportion (39%) in comparison to social demography and needs (61%). Few large regional imbalances were noted when needs-adjusted and supply-adjusted estimates were compared. Only two areas appeared to be underserviced in comparison to their local needs, reflecting approximately 6% of the provincial population.
While all three study factors proved important, findings support the broad conclusion that social demography and social risk (a proxy for need) will remain the key determinants predicting access to physician services for treatment of mental disorders in publicly funded health systems.
Despite the negative physical and mental health outcomes of sexual assault, a minority of sexually assaulted women seek immediate post-assault medical and legal services. This study identified the number and types of acute forensic medical procedures used by women presenting at a hospital-based urgent care centre between 1997 and 2001 within 72 hours following a reported sexual assault. The study also examined assault and non-assault factors associated with the use of procedures. It was hypothesized that assault characteristics resembling the stereotype of rape would be associated with the use of more procedures. The multiple regression indicated that injury severity, coercion severity, homelessness, and delay in presentation were significantly associated with the number of procedures received. Findings provide partial support for the hypothesis that post-assault procedures would be associated with the stereotype of rape, and highlight homeless women as a group particularly at risk for not receiving adequate medical treatment following a sexual assault.
To examine the prevalence of acute stress disorder (ASD) after a myocardial infarction (MI) and the factors associated with its development.
Of 1344 MI patients admitted to three Canadian hospitals, 474 patients did not meet the inclusion criteria and 393 declined participation in the study; 477 patients consented to participate in the study. A structured interview and questionnaires were administered to patients 48 hours to 14 days post MI (mean +/- standard deviation = 4 +/- 2.73 days).
Four percent were classified as having ASD using the Structured Clinical Interview for DSM-IV, ASD module. The presence of symptoms of depression (Beck Depression Inventory; odds ratio (OR) = 29.92) and the presence of perceived distress during the MI (measured using the question "How difficult/upsetting was the experience of your MI?"; OR = 3.42, R(2) = .35) were associated with the presence of symptoms of ASD on the Modified PTSD Symptom Scale. The intensity of the symptoms of depression was associated with the intensity of ASD symptoms (R = .65). The models for the detection and estimation of ASD symptoms were validated by applying the regression equations to 72 participants not included in the initial regressions. The results obtained in the validation sample did not differ from those obtained in the initial sample.
The symptoms of depression and the subjective distress during the MI could be used to improve the detection of ASD.
Comparison of outcomes among intensive care units (ICUs) requires adjustment for patient variables. Severity of illness scores are associated with hospital mortality, but administrative databases rarely include the elements of these scores. However, these databases include the elements of comorbidity scores. The purpose of this study was to compare the value of these scores as adjustment variables in statistical models of hospital mortality and hospital and ICU length of stay after adjustment for other covariates.
We used multivariable regression to study 1808 patients admitted to a 13-bed medical-surgical ICU in a 400-bed tertiary hospital between December 1998 and August 2003.
For all patients, after adjusting for age, sex, major clinical category, source of admission, and socioeconomic determinants of health, we found that Acute Physiology and Chronic Health Evaluation (APACHE) II and comorbidity scores were significantly associated with hospital mortality and that comorbidity but not APACHE II was significantly associated with hospital length of stay. Separate analysis of hospital survivors and nonsurvivors showed that both APACHE II and comorbidity scores were significantly associated with hospital length of stay and APACHE II score was associated with ICU length of stay.
The value of APACHE II and comorbidity scores as adjustment variables depends on the outcome and population of interest.
The purpose of this study was to examine the relationships between adolescent subjective well-being (SWB) and family dynamics perceived by adolescents and their parents. A sample of 239 pupils (51% female) from seventh and ninth grades completed the Berne questionnaire of SWB (youth form), two subscales from an original Finnish SWB scale and the Family Dynamics Measure II, and one of their parents (n = 239) filled in the Family Dynamics Measure II. Results indicated that parents assessed family dynamics better than did their adolescent child. Furthermore, there was no association between family dynamics perceived by adolescents and family dynamics assessed by one of their parents or between the adolescent SWB and parental perception of family dynamics. Multiple stepwise regression analysis indicated that certain aspects of family dynamics perceived by adolescents were related to adolescent global satisfaction and ill-being. Specifically, adolescents' perception of high level of mutuality and stability in the family as well as male gender and lack of serious problems in family were predictors of adolescent global satisfaction. Furthermore, disorganization in the family and poor parental relationship perceived by adolescents, being female, serious problems and illness in family predicted a high level of adolescent global ill-being.
BACKGROUND: The importance of early life conditions and current conditions for mortality in later life was assessed using historical data from four rural parishes in southern Sweden. Both demographic and economic data are valid. METHODS: Longitudinal demographic and socioeconomic data for individuals and household socioeconomic data from parish registers were combined with local area data on food costs and disease load using a Cox regression framework to analyse the 55-80 year age group mortality (number of deaths = 1398). RESULTS: In a previous paper, the disease load experienced during the birth year, measured as the infant mortality rate, was strongly associated with old-age mortality, particularly the outcome of airborne infectious diseases. In the present paper, this impact persisted after controlling for variations in food prices during pregnancy and the birth year, and the disease load on mothers during pregnancy. The impact on mortality in later life stems from both the short-term cycles and the long-term decline in infant mortality. An asymmetrical effect and strong threshold effects were found for the cycles. Years with very high infant mortality, dominated by smallpox and whooping cough, had a strong impact, while modest changes had almost no impact at all. The effects of the disease load during the year of birth were particularly strong for children born during the winter and summer. Children severely exposed to airborne infectious diseases during their birth year had a much higher risk of dying of airborne infectious diseases in their old age. CONCLUSIONS: This study suggests that exposure to airborne infectious diseases during the first year of life increases mortality at ages 55-80.
Comment In: Int J Epidemiol. 2003 Apr;32(2):294-512714552