Which personal quality of life domains affect the happiness of older South Africans?

Objective To ascertain which quality of life domains affect the happiness of older South Africans. Method Seven hundred and ten respondents, aged between 50 years and 93 years, participated in the study. Seven single items assessed satisfaction with: oneself, family life, friendship, one’s time to do things, neighbours, social life and health. Responses were summed for overall quality of life. A 31-item scale measured satisfaction with activities (16 items), financial situation (7 items) and people (8 items). One item measured global happiness. Results Coefficient alpha was 0.90 (7-item quality of life scale), 0.95 (activities scale) and 0.87 (finances and people scales). Although there some racial differences on the 10 quality of life domains and happiness, Black respondents, who acted as caregivers, had a poorer quality of life and were less happy (P < 0.05) than those without these responsibilities. Stepwise multiple regression revealed that satisfaction with social life was the most important predictor of happiness for Blacks and Indians; satisfaction with oneself for Whites, and time to do things for Coloureds. Overall findings suggested that three out of the ten domains adequately represented perceived quality of life, care-giving responsibilities negatively affect quality of life and happiness and race plays a role in predicting happiness.     

Socio-medical indicators of health in South Africa

Socio-medical indicators developed by WHO for monitoring progress towards Health-for-All have been adapted to reveal, clearly and objectively, the devastating impact of state planning based on an outmoded immoral and unscientific philosophy of race superiority in South Africa on the health of the disenfranchised majority within the context of social and economic discrimination; Health policy indicators confirm that the government is committed to three options (Bantustans, A New Constitution, and A Health Services Facilities Plan) all of which are inconsistent with the attainment of Health-for-All; Social and economic indicators reveal gross disparities between African, Coloured, Indian, and White living and working conditions; Provision of health care indicators show the overwhelming dominance of high technology curative medical care consuming about 97 percent of the health budget with only minor shifts towards community-based comprehensive care; and Health status indicators illustrate the close nexus between privilege, dispossession and disease with Whites falling prey to health problems related to affluence and lifestyle, while Africans, Coloureds, and Indians suffer from disease due to poverty. All four categories of the indicator system reveal discrepancies which exist between Black and White, rich and poor, urban and rural. To achieve the social goal of Health-for-All requires a greater measure of political commitment from the state. We conclude that it is debatable whether a system which maintains race discrimination and exploitation can in fact be adapted to provide Health-for-All.     

The health of the urban black in the South African context

The state of medicine in South Africa is a mixture of development and under-development. The Whites have the disease patterns typical of highly-industrialised western countries. By reason of their privileged position they have also abrogated to themselves most of the medical resources so that sophisticated health services for Whites can only exist at great cost to the Black population which bears the main burden of disease in the country. Infectious and epidemic diseases due to poor environmental conditions do not occur in the White population and they are also protected from most industrial accidents as they perform work which is largely supervisory, technical or professional. Among Blacks the major health problems relate to poverty, lack of adequate sanitation and water, over-crowded housing and the occupational hazards of low status workers poorly protected in many cases from industrial accidents. The high increase of infectious and epidemic diseases, particularly in the early years of life as well as tuberculosis are indicative of the difference between the two groups. During 1980 and again in 1981 there have been severe outbreaks of cholera among Black rural populations illustrating the failure of the society to provide its citizens with an unpolluted water supply, but this problem does not receive urgent attention in a country which instead pioneers new techniques in heart transplant surgery.However, the health problems of all Blacks in the Republic of South Africa are becoming differentiated today in terms of rural urban dichotomy. Because the modern sector of the economy needs permanently urbanised workers able to produce efficiently as well as reproduce themselves, some measure of attention has been given to the improvement of the environmental conditions and the health services of the worker in the city. This paper proposes that we consider the disease patterns and access to health care in South Africa in terms of three tiers of health with the Whites in the first tier, the urban Black population in the second tier and the rural Black in the third tier. this paper focuses on the position of the Blacks in the second tier and it shows that some of their most urgent health problems have received attention, yet in contrast with the Whites, in the first tier, glaring inequalities remain. But almost two-thirds of the Black population remains rural and the most signicant imbalance in terms of health is not being redressed.     

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents

The purpose of this study was to test a conceptual model basedon theoretical and empirically supported relationships relatedto the influences of weight perceptions, weight concerns, desiresto change weight, friends, age and location in relation to physicalactivity (PA) and smoking in adolescents. A total of 1242 malesand 1446 females (mean age = 15.6 ± 1.3) were recruitedfrom rural and urban Canadian schools. Study respondents providedself-reports of PA, ‘smoking’, ‘perceivedbody weight’, ‘desire to change weight’, ‘concernabout weight gain’ and ‘friends' smoking and PAbehaviors’. Results revealed an acceptable fitting model² (40) = 155.63, P < 0.05, root mean square error of approximation= 0.047 and comparative fit index = 0.98. Large effect sizesfor both genders were observed between friends' and adolescents'smoking behavior, and between perceived body weight and desireto change weight. Further, significant differences were identifiedbetween the male and female models [² difference (24) = 65.28,P < 0.05]. Several findings of this study point to the needto design programs to motivate adolescent females to adopt healthyweight-control practices and to target young peoples' socialnetworks to promote health behaviors, especially with regardto smoking. Received on December 22, 2005; accepted on June 15, 2006     

The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample

This study examines the association between perceived discrimination and underutilization of needed medical and mental health care, in a representative, multi-ethnic community sample. Data were derived from a cross sectional survey of 10,098 White, U.S.-born Black, African-born Black, American Indian, Hispanic, and Southeast Asian adults in Hennepin County, Minnesota. Even after controlling for socio-demographic characteristics, health care access, and physical and mental health, perceived discrimination was associated with underutilization of medical care among Whites, U.S.-born Blacks, and American Indians and was associated with underutilization of mental health care among Whites, U.S.-born Blacks, Southeast Asians, and American Indians. Correlates of different types of discrimination (major, everyday, health care) on underutilization of care varied among ethnic groups. The higher prevalence of discrimination among racial and ethnic minorities may contribute to their underutilization of health care services. Future research is needed to understand the impacts of different types of discrimination on different groups.     

Corrigendum

In the article by Goran Sjönell in September 1986 issueof Family Practice ‘Effect of establishing a primary healthcare centre on the utilization of primary health care and otherout-patient care in a Swedish urban area’, some referenceswere omitted which may be useful to readers: Sjönell G. Relationship between use of increased primaryhealth care and other out-patient care in a Swedish urban area.1. Utilization of public primary health care. Scand J Prim HealthCare 1984; 2: 33–39. Sjönell G. Relationship between use of increased primaryhealth care and other out-patient care in a Swedish urban area.II. Utilization of outpatient hospital services. Scand J PrimHealth Care 1984; 2: 77–83. Sjönell G. Relationship between use of increased primaryhealth care service and other care in a Swedish urban area.III. Utilization of emergency house calls. Scand J Prim HealthCare 1984; 2: 133–139. Sjönell G. Relationship between use of increased primaryhealth care and other out-patient care in a Swedish urban area.IV. Use of private and other non public out-patient care. ScandJ Prim Health Care 1984; 2: 181–188.     

Perceived discrimination, race and health in South Africa

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.     

A Secondary Analysis of Smoking Among Rural and Urban Youth Using the MTF Data Set

ABSTRACT: This paper compares rural and urban youth cigarette-smoking behavior using the Monitoring the Future data set, a national, probability-based, multi-stage sample design. Cigarette smoking was examined by region, race, and gender over time. Results indicated that rural White males smoked more ofen (30-day prevalence of 34%) than any other group. Urban Black males smoked the least (10%). Urban White females smoked more (30-day prevalence of 33%) than urban Black females (7%). In general, rural and urban Whites reported smoking at significantly higher rates than rural and urban Blacks. Smoking rates declined steadily for both rural and urban Black females and urban Black males over the study period. These data document distinctive patterns of tobacco use among the nation's youth, which can be used by program planners for specific targeted interventions.     

Who gets what: politics, evidence, and health promotion

Science journal, starting with its July 2005 issue, presentsits readers with 125 questions and problems yet to be resolvedby the scientific community. These range from the deceptivelysimple (‘what is the structure of water?’), theobvious (‘what triggers puberty?’ or ‘whatare the roots of human culture?’), to the amazingly esoteric(‘do mathematically interesting zero-value solutions ofthe Riemann zeta function all have the form of a+bi?’). More than half of these issues have     

Helping people change--an ethical approach?

This paper is a normative analysis of an empowerment approachin health promotion. In particular it utilizes two increasinglyinfluential idioms of normative analysis (analytic health careethics and Foucauldian analysis) to evaluate the ethics of ‘helpingpeople change’. The HEA pack entitled ‘Helping PeopleChange’ (HPC) is used as an exemplary case study and asa starting point for analysis; but the implications are intendedto be more wide ranging and the purpose of the analysis is two-fold.First, ethical discussion is presented as an important dimensionof the substantive evaluation of HPC-type interventions (i.e.interventions which emphasize support for voluntary change).Second, it is presented as a means of comparing and contrastingthe role of the two normative idioms in such ethical evaluation.The aims and the underlying rationale of the HPC pack are setout. Analytic health care ethics is represented by the well-known‘four principles’ approach and the longest sectionof the paper applies each of these principles in turn (beneficence,non-maleficence, autonomy and justice) to the HPC pack. It isargued that for each principle there are ethical difficultiesattaching to HPC-type interventions. This is (albeit superficially)paradoxical given that such interventions are arguably exemplaryand are self-consciously ‘ethical’. It is here thata Foucauldian perspective presents a sharp contrast. Accordingto such a perspective, it is argued, the idea of helping peoplechange is ‘obviously’ questionable. This is becauseFoucauldian analysis centres around the intimate links betweenempowerment, control and ‘the creation of subjects’.Finally, some of the other contrasts between, and the potentialcomplementarity of, the two normative perspectives are brieflyreviewed.     

The impact of the COSHH regulations on workers with occupational asthma

In the UK, the COSHH Regulations give specific guidance thatemployers have duties to inform, instruct and train their employeesabout occupational risks and provide them with suitable healthsurveillance. The aim of the study was to evaluate the impactof the Regulations on employees with occupational asthma. Onehundred consecutive patients attending an occupational lungdisease clinic completed a questionnaire assessing the implementationof the COSHH Regulations in their workplace. Twenty-eight percent had a pre-employment inquiry about asthma, 31% had regularhealth surveillance by questionnaires and 19% had regular lungfunction assessment at work. Pre-employment spirometry was carriedout in 44% of the workers who were exposed to one of the originalseven prescribed agents, significantly more than those who wereexposed to other agents (19%) (p < 0.05). Moreover, figuresfor spirometry during employment were 31% and 8% respectively(p < 0.05). The patients who worked after ‘COSHH’but before ‘MS25’ had a tendency to be providedwith health surveillance more than those who worked after both‘COSHH’ and ‘MS25’. Ninety-one per centof the patients had never been informed about the risks of gettingasthma at work and 73% had never seen the safety data sheets.The workers who (1) worked after ‘COSHH’ introduction;(2) worked in larger firms and (3) were exposed to one of theoriginal seven prescribed agents, had a tendency to be informed,instructed and trained more than the rest. However, there wereonly significant statistical differences (p<0.05) in termsof the safety data sheet provision between the cases who workedbefore the time of the legislation and those employed afterwards.     

ERRATUM

The title of the editorial in the Journal of the Society forOccupational Medicine, 25, p. 1 should have been ‘ A HopefulProspect ’. Page 34, line 6 in the paragraph ‘ ScientificMeetings ’ should have read ‘ The Provincial Meetingwas held in York ’.     

ALCOHOLISM: A LONG-TERM FOLLOW-UP STUDY OF PARTICIPANTS IN AN ALCOHOL TREATMENT PROGRAMME

This paper reports the results of a long-term follow-up studyof 112 alcoholic patients admitted to an intensive 1-month residentialprogramme. Outcomes at the 6-month and 1-year stages were reportedin an earlier paper [G. K. Shaw et al. (1990) British Journalof Psychiatry 157, 190–196]. The length of the follow-upperiod in this study was an average of 9 years. Eighteen patientshad died before the long-term follow-up stage, and of the remaining94 a total of 60 patients were followed up. This study showsthat major improvements on social, psychological and drinkingbehaviour measures, made at 6 months and 1 year follow-up, were,on the whole, maintained and there was a progressive improvementon most variables at each follow-up stage. Major improvementswere achieved by those patients whose drinking was categorizedas ‘abstinent’, ‘controlled’ and ‘improved’.The proportion of patients categorized as ‘unchanged’dropped from 43% at 6 months to 33% at 1 year and to 15% at9 years. By the 1-year follow-up stage, the unchanged groupshowed deterioration on psychological variables such as neuroticism,self-esteem and satisfaction with life situations, continuedto make use of health service resources, and the high levelof alcohol-related physical and social complications remainedunchanged. This group had similar results at long-term follow-upwith the exception of neuroticism, which was significantly lowerin all drinking categories.     

ERRATUM

In the article by A. L. Morgan ‘Cholinesterase Problemsarising in a Plant Manufacturing Tri-aryl Phosphates’(Journal of the Society of Occupational Medicine 31, 119–122)on p. 120, the first sentence of Case 1 should read ‘Thisindividual had three split blood samples examined.’     

An audit of occupational medicine consultation records

There is a need to develop and test methods of audit of theconsultation process in occupational medicine and to draw conclusionsfrom the findings. An external audit was carried out on 313randomly selected consultation records from the occupationalhealth services of three health boards over a 26-month period.Additionally, nine months after the date of the first externallyaudited sample, a prospective internal audit was commenced withinone board. In 58 of the consultations selected (19 per cent),audit was not possible mainly because records could not be found.In an appreciable proportion of the rest, there were shortcomingsin the referral record or in the consultation record. The consultationrecords of ‘career’ occupational physicians werebetter than those of ‘non-career’ physicians, especiallyin recording specific diagnoses (91 per cent vs. 67 per cent;P<0.0001) and in conclusions regarding occupational implications(86 per cent vs. 74 per cent; P<0.0001). Multivariate regressionsshowed a highly significant improvement associated with prospectiveinternal audit in one item, namely the record of occupationalimplications. However, the magnitude of this difference beforeand after audit was smaller than the independent differencearising from the career status of the physicians. The valueof medical audit in improving quality of care and educationin occupational medicine is discussed.     

Racial differences in rural adults' attitudes toward issues of adolescent sexuality.

This study, based on a random sample of adults in a rural North Carolina county, demonstrates racial differences in rural adults' attitudes relating to adolescent sexual issues. Blacks were 50% more likely than Whites to indicate that public schools should provide general health care services, including pregnancy testing and treatment of sexually transmitted diseases, to teenagers; however, they were only half as likely as Whites to approve of sexual experimentation by adolescents. The local community's attitudes must be considered in the implementation of rural adolescent health programs, including acquired immunodeficiency syndrome education.     

Moderation of the Association between Media Exposure and Youth Smoking Onset: Race/Ethnicity, and Parent Smoking

This study of youth smoking onset aims to replicate previously published media moderation effects for race/ethnicity in a national longitudinal multiethnic sample of U.S. adolescents. Previous research has demonstrated that associations between media and smoking during adolescence are greater for Whites than Hispanics or Blacks, and for youth living in non-smoking families. In this study, changes in smoking status over 24 months were assessed among 4,511 baseline never-smokers. The incidence of smoking onset was 14.3% by 24 months with no differences by race/ethnicity. Blacks had higher exposure to movie smoking and overall television viewing compared with Whites and Hispanics. Whites responded to movie smoking regardless of parent smoking but more strongly if their parents were non-smokers. In contrast, Black adolescents showed little behavioral response to any media, regardless of parent smoking. Hispanic adolescents responded only to TV viewing and only when their parents did not smoke. In an analysis assessing the influence of the race of smoking characters on smoking behavior of White and Black adolescents, Whites responded to both White and Black movie character smoking, whereas Blacks responded only to smoking by Black movie characters. Taken as a whole, the findings replicate and extend previous findings, suggesting media factors are more influential among adolescents at low to moderate overall risk for smoking. We draw analogies between these low-moderate risk adolescents and “swing voters” in national elections, suggesting that media effects are more apt to influence an adolescent in the middle of the risk spectrum, compared with his peers at either end of it.     

Factor analysis as a tool in community diagnosis

For the family physician, community diagnosis can be likenedto individual diagnosis by the application of methods of informationacquisition and analysis. This paper describes the techniqueof factor analysis, applied to data from an urban inner-cityarea, for reducing a multitude of factors to a manageable numberwithout an appreciable loss of information. The variables wereselected from four broad categories which have been shown toinfluence both health states and health care needs: demography,socioeconomics, social disorganization and morbidity/mortality.A correlation matrix based on 40 of the most accessible indicesserved as input for a principal axes factor analysis. Six factors acounted for 74% of the total variance and wereinterpreted as: ‘Poverty and social disorgan ization’,‘Distribution and problems of the elderly’, ‘Ethniccomposition’, ‘Fertility’, ‘Infant mortality’and ‘Foetal mortality’. Representative indices fromeach factor were then mapped to identify and display censustract differences. Finally, the application of the factors toa specific community illustrated important differences withinthe community and identified areas of high risk and need.