Community indicators of child health

Indicators of health in child populations are critically reviewed and the potential for routinely collected morbidity and life quality data discussed. A short list of currently available, routinely collected child health data is proposed which, if available for all European countries, would form the basis of a useable and comparable European child health data base. A European consensus group on child health indicators is proposed and further research into morbidity and life quality measures relevant to children recommended.     

Environmental determinants of memory improvement in late adulthood.

Conducted 2 studies with 99 nursing home residents (mean age ranges 76.2–80.7 yrs) to determine whether memory could be improved. This was accomplished by increasing the cognitive demand of the environment and then varying the extent to which Ss were motivated to attend to and remember these environmental factors. In Study 1, motivation to practice recommended cognitive activities was manipulated by varying the degree of reciprocal self-disclosure offered by interviewers in a series of dyadic interactions. In Study 2, motivation to practice recommended cognitive activities was manipulated by varying whether positive outcomes were contingent on attending to and remembering these activities, which increased in demand over time. In both studies, engaging in cognitive activity resulted in improvement on standard short-term memory tests, including probe recall and pattern recall, as well as in improvement on nurses' ratings of alertness, mental activity, and social adjustment for experimental groups relative to controls. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socioeconomic determinants of health. Children, inequalities, and health

This article describes a growing body of evidence showing the adverse effects of the widening income gap on the health and welfare of children and young people. The effects of this go well beyond morbidity and mortality and can also be seen in the areas of crime, violence, and educational attainment. There is a need for evidence based policy in this area, but meanwhile there is scope for intervention in pregnancy and the early years, and good evidence that this is effective. A number of well evaluated interventions not necessarily directly related to health, such as early learning programmes and social support for parents, promise to have beneficial health effects.     

A classification of sociomedical health indicators: perspectives for health administrators and health planners

The conceptualization and operationalization of measures of health status are considered. Health indicators are conceived as a subset of social indicators, and therefore, as any social indicator, they are viewed as derivative from social issues. The interrelationships of different frames of reference for defining and measuring health that have accompained three distinct health problem patterns in the United States are viewed from a developmental perspective. Mortality and morbidity rates, the traditional health indicators, by themselves no longer serve to assess health status in developed nations. Their deficiencies as indicators serve as background for a classification schema for sociomedical health status indicators that relates health definition frames of reference, measures of health status, and health problems. The role of a group of health indicators-sociomedical heath indicators-in the current formulation of health status measures is assessed.     

Comments on health indicators: methodological perspectives

This paper discusses several basic conceptual and methodological problems in the development and use of health indicators. We observe that two tendencies of the health indicators movement may deter progress toward producing informations of health status indexes and the tendency to conceptualize "health" in terms of expansive definitions should measure variables specified by a social system model and should be scaled according to units that are relevant to decision-making criteria.     

The use of health indicators in environmental assessment

Environmental assessment (EA) is required in Canadian federal and provincial jurisdictions as part of the process for decision-making on the acceptability of development projects. With increasing recognition of the relationship between environment and health, assessing "health" impact has growing importance. This paper presents the framework that is being developed by the World Health Organization (WHO) for addressing environmental health indicators, reports on the findings of a series of five regional workshops held in 1995-96 to examine the role of health professionals in environmental assessment in Canada, and presents a case study illustrating how human health has been addressed in a prominent EA conduct in northern Saskatchewan. Opportunities for future development of environmental health indicators are considered, with special reference to the potential use of medical data to address these challenges.     

Socioeconomic determinants of health. The contribution of nutrition to inequalities in health

Social class differences in health are seen at all ages, with lower socioeconomic groups having greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including lack of breast feeding, smoking, physical inactivity, obesity, hypertension, and poor diet are clustered in the lower socioeconomic groups. The diet of the lower socioeconomic groups provides cheap energy from foods such as meat products, full cream milk, fats, sugars, preserves, potatoes, and cereals but has little intake of vegetables, fruit, and wholewheat bread. This type of diet is lower in essential nutrients such as calcium, iron, magnesium, folate, and vitamin C than that of the higher socioeconomic groups. New nutritional knowledge on the protective role of antioxidants and other dietary factors suggests that there is scope for enormous health gain if a diet rich in vegetables, fruit, unrefined cereal, fish, and small quantities of quality vegetable oils could be more accessible to poor people.     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of quality of life indicators among selected patients in a community cancer center

Quality of life and outcome assessments are particularly critical for nurses in assessing clinical care for diseases such as cancer because of potential mortality and the exacting modalities of treatment. The 278 study participants were patients at the M.D. Anderson Cancer Center Orlando. The respondents were assessed with the Health Status Questionnaire (HSQ; D. M. Radosevich, H. Wetzler, & S. M. Wilson, 1995). Prostate cancer patients scored higher (had a higher quality of life) on average (6.08%) than breast cancer patients on all subscales except Physical Functioning. The diagnostic center patients scored higher (9.68%) than breast cancer patients and prostate cancer patients (3.47%). Breast cancer respondents scored 16.61% lower than the normative values for individuals less than 65 years of age, whereas prostate cancer respondents scored 10.91% higher than the normative values for those older than 65. The data analysis confirmed that breast cancer and prostate cancer patients have statistically different scores on the HSQ, implying different quality of life concerns for each group.     

Health for all: analyzing health status and determinants

Several clinical disorders are strongly influenced by hormones involved in appetite and weight regulation. Obesity and eating disorders are of major importance, because they are associated with severe morbidity and considered to be among the greatest health problems in the Western world today. This review describes recent findings in hormonal regulation of food intake by substances acting both centrally, such as corticotropin-releasing factor, neuropeptide Y and leptin, and peripherally, such as cholecystokinin and somatostatin. Sex hormones and glucocorticoids play an important role in long-term regulation of metabolism. The role of these hormones in appetite and weight changes during life as well as during pregnancy and lactation is discussed. Furthermore, the development of obesity and eating disorders is influenced, in particular, by steroid hormones. Treatment with sex hormones, as in hormone replacement therapy, affects appetite and weight and may have beneficial effects in preventing android obesity. Currently, there is great effort in developing endogenous neurohumoral substances into effective drugs for the treatment of obesity and eating disorders. Leptin and neuropeptide Y analogues are of interest as potential antiobesity agents.     

Social-cognitive determinants of hoist usage among health care workers.

Injuries caused by unsafe manual handling of patients are a major source of ill health in health care workers. The present study evaluated the ability of 4 classes of variable to predict use of a hoist when moving a heavily dependent patient. Variables examined were occupational role characteristics, such as hours of work and type of shift worked; biographics, including age and height; aspects of occupational context, such as number of hoists available and number of patients; and motivational variables specified by the theory of planned behavior (Ajzen, 1985) and protection motivation theory (Rogers, 1983). Regression analyses showed that background and social-cognitive variables were able to account for 59% of variance in intention to use a hoist and 41% of variance in use of the hoist assessed 6 weeks later. Height, hoist availability, coworker injunctive norm, perceived behavioral control, response cost, response benefits, and social and physical costs of not using the hoist each explained independent variance in motivation to use a hoist at work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dietary determinants of ischaemic heart disease in health conscious individuals

OBJECTIVE: To investigate dietary determinants of ischaemic heart disease (IHD) in health conscious individuals to explain the reduced risk in vegetarians, and to examine the relation between IHD and body mass index (BMI) within the normal range. DESIGN: Prospective observation of vegetarians, semi-vegetarians, and meat eaters for whom baseline dietary data, reported weight and height information, social class, and smoking habits were recorded. SUBJECTS: 10,802 men and women in the UK aged between 16 and 79, mean duration of follow up 13.3 years. MAIN OUTCOME MEASURES: Death rate rations for IHD and total mortality in relation to dietary and other characteristics recorded at recruitment (reference category death rate = 100). RESULTS: IHD mortality was less than half that expected from the experience reported for all of England and Wales. An increase in mortality for IHD was observed with increasing intakes of total and saturated animal fat and dietary cholesterol-death rate ratios in the third tertile compared with the first tertile: 329, 95% confidence interval (CI) 150 to 721; 277, 95% CI 125 to 613; 353, 95% CI 157 to 796, respectively. No protective effects were observed for dietary fibre, fish or alcohol. Within the study, death rate ratios were increased among those in the upper half of the normal BMI range (22.5 to < 25) and those who were overweight (BMI > or = 25) compared with those with BMI 20 to < 22.5. CONCLUSIONS: In these relatively health conscious individuals the deleterious effects of saturated animal fat and dietary cholesterol appear to be more important in the aetiology of IHD than the protective effect of dietary fibre. Reduced intakes of saturated animal fat and cholesterol may explain the lower rates of IHD among vegetarians compared with meat eaters. Increasing BMI within the normal range is associated with increased risk of IHD. The results have important public health implications.     

The relationship between stress and health indicators in an urban population--from a study of subjects selected by sex and age groups who underwent health check-ups in S city in Osaka Prefecture]

The role of fatty acids (FA) as a mediator and modulator of central nervous system activity in general, and peptides in particular, is only recently becoming understood. This paper reviews numerous findings concerned with the activity of fatty acids, particularly with their interaction with diverse neurochemical systems and their consequences for better understanding neurotransmitters, hormones and peptides. The effects include FA as precursors in the manufacture of neurochemical elements, including enzymes, neurotransmitters, and hormones. Of particular interest is the important changes in neuronal membrane composition that have been attributed to FA. Such changes may account for the changes in thermoregulation, learning, and other functions that accompany dietary manipulation of FA intake. While the total level of FA has been the object of many investigations, this report addresses the need to focus on the ratio of FA, especially alpha-linolenic/linoleic acid, which has been shown to be a critical factor in a number of research studies.     

Environmental and personal determinants of support perceptions: Three generalizability studies.

The extent to which perceived social support reflects characteristics of the environment, the personality of the perceiver, and their interaction is unknown. This article shows how the methods of generalizability theory can be used to address these questions. When participants rate the same targets on the targets' supportiveness, generalizability theory provides methods for determining the extent to which support judgments are determined by effects due to targets (supporters), perceivers, and their interaction. In 3 studies, each source of variance made significant contributions to support judgments, with the Perceivers?×?Supporters interaction, characteristics of supporters, and biases of perceivers making the largest contributions, respectively. The implications for theoretical models of perceived support are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal analysis of multiple indicators of health decline among spousal caregivers

CONCLUSION: In view of the frequent absence of symptoms related to pancreatic lesions, screening tests for VHL should always include assessment of the pancreas and, considering the frequency of polycystic manifestations, VHL should always be borne in mind in the differential diagnosis of multiple pancreatic cysts, especially when occurring in young patients and in the absence of a positive history of pancreatic disease. BACKGROUND: Von Hippel-Lindau disease (VHL) is a hereditary disease transmitted with an autosomal dominant character and characterized by hemangioblastomas of the central nervous system and retina, renal tumors and cysts, and pheochromocytoma. Pancreatic manifestations of VHL are reported in the literature with incidences ranging from 16 to 29% of cases and consist mainly in cystadenomas of the serous type and in multiple cystic lesions, often with complete replacement of the gland. METHODS AND RESULTS: We report five cases of VHL with a polycystic pancreas as the main or only manifestation, all devoid of symptoms related to involvement of the pancreas, who were referred to our Pancreatic Surgery center with diagnoses of multiple pancreatic pseudocysts of undefined origin.     

A review of relationships between active living and determinants of health

To clarify the relationship between selenium (Se) deficiency and functional disorders, the authors determined the Se concentration, anti-oxidant enzyme activity, and other parameters in rats fed a Se-deficient diet. Rats fed the Se-deficient diet showed a decrease in Se concentration and glutathione peroxidase (GSH-Px) activity in plasma, erythrocytes, heart, liver, and skeletal muscle from the first week after the initiation of the diet, an increase in heart lipid peroxide concentration from the second week, and an increase in liver glutathione S-transferase activity from the fourth week. From the twelfth week, a decrease in the growth rate in the rats fed the Se-deficient diet was observed. In spite of this growth impairment, no changes in electrocardiogram, muscle tone, degree of hemolysis, plasma biochemistry, or hematological values were detected. In summary, the authors found that a reduction of body Se is easily induced, but that the appearance of functional disorders following Se deficiency is difficult to detect in rats.     

Measuring inequalities in health in the presence of multiple-category morbidity indicators

This paper considers the problems which arise in seeking to measure socioeconomic inequalities in health when the health indicator is a categorical variable, such as self-assessed health. It shows that the standard approach--which involves dichotomizing the categorical variable--is unreliable. The degree of measured inequality is found to depend on the cut-off point chosen and the choice of cut-off point to affect the conclusions one can reach about trends in or differences in health inequality. The paper goes on to propose an alternative approach which involves constructing a latent health variable and then measuring inequalities in this latent variable by means of a variant of the health concentration curve.     

Environmental differentiation and familiarity as determinants of children's memory for spatial location.

The degree to which 2 environmental variables, familiarity and differentiation, affect the ability of children to recall the spatial location of an event was assessed in 3 experiments with a total of 72 3-5 yr old preschoolers and 16 7-8 yr olds. In each study Ss were taken individually on strolls through a variety of environments, were exposed to an event, and later were asked to recall where that event had occurred. This procedure was followed on 1 occasion without the S's foreknowledge that such a request would be made, and on a 2nd occasion with foreknowledge of the S. Differentiation and foreknowledge both had a significant effect on the ability of preschool Ss to perform in this task, but familiarity did not. 8-yr-olds were significantly more accurate than preschoolers in an undifferentiated environment but not in a differentiated environment. Results support Piaget's theory that the development of spatial representation proceeds from dependence on topological spatial relations to incorporation of projective and Euclidean concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)