Women’s knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women’s Health in Midlife Study

Abstract

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45–64 years were conducted during 2004–2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about “warning signs of a heart attack” and “family history.” Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients’ personal status by health providers.     

Prevalence of Metabolic Syndrome Associated with Body Burden Levels of Dioxin and Related Compounds among Japan’s General Population

Background

Environmental exposure to some persistent organic pollutants has been reported to be associated with a metabolic syndrome in the U.S. population.

Objectives

We evaluated the associations of body burden levels of dioxins and related compounds with the prevalence of metabolic syndrome among the general population in Japan.

Methods

We conducted a cross-sectional study with 1,374 participants not occupationally exposed to these pollutants, living throughout Japan during 2002–2006. In fasting blood samples, we measured biochemical factors and determined lipid-adjusted concentrations of 10 polychlorinated dibenzo-p-dioxins (PCDDs), 7 polychlorinated dibenzofurans (PCDFs), and 12 dioxin-like poly-chlorinated biphenyls (DL-PCBs) all of which have toxic equivalency factors. We also performed a questionnaire survey.

Results

The toxic equivalents (TEQs) of PCDDs, PCDFs, and DL-PCBs and total TEQs had significant adjusted associations with metabolic syndrome, whether or not we excluded diabetic subjects. By analyzing each component of metabolic syndrome separately, the DL-PCB TEQs and total TEQs were associated with all components, and the odds ratios (ORs) in the highest quartile of DL-PCB TEQs in four of the five components were higher than those for PCDDs or PCDFs. We also found congener-specific associations with metabolic syndrome; in particular, the highest quartiles of PCB-126 and PCB-105 had adjusted ORs of 9.1 and 7.3, respectively.

Conclusions

These results suggest that body burden levels of dioxins and related compounds, particularly those of DL-PCBs, are associated with metabolic syndrome. Of the components, high blood pressure, elevated triglycerides, and glucose intolerance were most closely associated with these pollutants.     

Factors Associated with Colorectal Cancer Screening among a Low-Income,Multiethnic, Highly Insured Population: Does Provider’s Understanding of the Patient’s Social Context Matter?

The primary aim of this paper was to explore whether provider’s understanding of patient’s social context is associated with screening uptake, independent of provider’s recommendation. Baseline data were collected in 2004–2005 from a cluster randomized control trial in 12 low-income housing sites. Participants included 695 low-income, multiethnic adults aged 50 years and over who were primarily insured (97%). Provider’s recommendation was significantly associated with current adherence to colorectal cancer (CRC) screening. Provider’s understanding of patient’s social context, as operationalized by how well participants felt that their provider knew (a) their responsibilities at work, home, or school; (b) their worries about health; and (c) them as a person and their values and beliefs, was also significantly associated with current adherence to screening, independent of provider’s recommendation. Participants who reported that their provider knew them well on two or three items were significantly more likely to be current with CRC screening compared to those who reported their provider knew them well on only one or none of the items (odds ratio = 1.56; 95% confidence interval = 1.06, 2.29). Our findings indicate that provider’s understanding of patient’s social context, independent of provider’s recommendation for CRC screening, contributed to adherence to CRC screening in this low-income, multiethnic population.     

Hunger and Food Insecurity in Nairobi’s Slums: An Assessment Using IRT Models

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious that a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory models to infer a reliable and valid measure of hunger and food insecurity relevant to low-income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System. The reliability and accuracy of the items are tested using both the Mokken scale analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households’ economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food-secure, and nearly half of all households are categorized as “food-insecure with both adult and child hunger.” Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children.     

Men’s knowledge and attitudes about cervical cancer screening in Kenya

Background

A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women’s utilization of screening and treatment.

Methods

We administered an oral survey to 110 men in Western Kenya about their knowledge and attitudes regarding cervical cancer and cervical cancer screening. Men who had female partners eligible for cervical cancer screening were recruited from government health facilities where screening was offered free of charge.

Results

Specific knowledge about cervical cancer risk factors, prevention, and treatment was low. Only half of the men perceived their partners to be at risk for cervical cancer, and many reported that a positive screen would be emotionally upsetting. Nevertheless, all participants said they would encourage their partners to get screened.

Conclusions

Future interventions should tailor cervical cancer educational opportunities towards men. Further research is needed among both men and couples to better understand barriers to male support for screening and treatment and to determine how to best involve men in cervical cancer prevention efforts.

     

Assessment of Environmental Health Children’s Population Living in Environmental Injustice Scenarios

We conducted a cross sectional study, involving 145 children randomly selected from three different socioeconomic locations. We selected social, environment and health indicators and measured the prevalence and prevalence odds ratios. Children from the brick producing site (segregation index 5), are exposed to high levels of multiple toxic agents, and showed the highest morbidity rates and malnutrition, anemia, dental fluorosis, and the lowest IQ, followed by children from municipal garbage dump (segregation index 4), where we detected the highest prevalence of dermatological and enteric diseases. Children from the Central Zone (segregation index 2) showed the lowest rates of malnutrition and higher IQ than the other two groups. A unified vision of social, health and environmental indicators opens the possibility of novel intervention programs and a legal framework that specifically protect children against environmental exposures.     

Access and utilization of HIV treatment and services among women sex workers in Vancouver’s downtown eastside

Many HIV-infected women are not realizing the benefits of highly active antiretroviral therapy (HAART) despite significant advancements in treatment. Women in Vancouver’s Downtown Eastside (DTES) are highly marginalized and struggle with multiple morbidities, unstable housing, addiction, survival sex, and elevated risk of sexual and drug-related harms, including HIV infection. Although recent studies have identified the heightened risk of HIV infection among women engaged in sex work and injection drug use, the uptake of HIV care among this population has received little attention. The objectives of this study are to evaluate the needs of women engaged in survival sex work and to assess utilization and acceptance of HAART. During November 2003, a baseline needs assessment was conducted among 159 women through a low-threshold drop-in centre servicing street-level sex workers in Vancouver. Cross-sectional data were used to describe the sociodemographic characteristics, drug use patterns, HIV/hepatitis C virus (HCV) testing and status, and attitudes towards HAART. High rates of cocaine injection, heroin injection, and smokeable crack cocaine use reflect the vulnerable and chaotic nature of this population. Although preliminary findings suggest an overall high uptake of health and social services, there was limited attention to HIV care with only 9% of the women on HAART. Self-reported barriers to accessing treatment were largely attributed to misinformation and misconceptions about treatment. Given the acceptability of accessing HAART through community interventions and women specific services, this study highlights the potential to reach this highly marginalized group and provides valuable baseline information on a population that has remained largely outside consistent HIV care.     

Health Promotion and Managed Care:: Surveys of California’s Health Plans and Population

Introduction:The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competetive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans.Methods:A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs.Results:California’s HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%–3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%–45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs.Conclusion:For the majority of California’s PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.     

Life Events and the Onset of Celiac Disease from a Patient’s Perspective

Stressful events have been investigated in various immune-mediated diseases but not in celiac disease. Our aim was to examine the relationship of stressful events assessed by the standardized interview of Paykel with the diagnosis of celiac disease in comparison to patients, with a diagnosis of gastroesophageal reflux disease used as the control group. Adults with celiac disease (n = 186) reported more frequent and more severe life events in the years prior to the diagnosis than control patients (n = 96) (67.2% vs. 37.5%, p < 0.001, mean Paykel score 11.5 vs. 13.4, p = 0.001, respectively). Findings were not significantly different between celiac disease and control patients for the time lapse between the event and the diagnosis (mean 5.5 vs. 5.7 months). Pregnancy was defined as a negative event by 20.3% of celiac women, but never by control women. Findings were confirmed when analyses were repeated in the subgroup of patients of both groups with diagnosis made within one year of onset of symptoms. Data indicate that, before diagnosis, the number of stressful events in celiac disease was more frequent although less severe than in the control group suggesting that life events may favor the clinical appearance of celiac disease or accelerate its diagnosis.     

The Cost of Lung Cancer Management in France from the Payor’s Perspective

Background

We assessed the average management cost per case of lung cancer in France according to the histological type and stage at diagnosis, together with the cost of each component of different treatment strategies.

Methods

The sample was drawn from public and private hospitals that were treating large numbers of patients. The study covered the period from 1 July 1998 to 30 June 1999 and was based on medical chart review. A Markov model with six decision trees (two for small cell lung cancer [SCLC] and four for non-small cell lung cancer [NSCLC]) was used for the cost analysis. Treatment was broken down into first-line and second-line strategies, surveillance, and terminal care (TC).

Results

The average management costs were €22 006 (€10 631–36 296) for 1 year and €25 643 (€10 631–41 191) for 2 years. The 2-year average costs were €22 420 for disseminated SCLC and €27 098 for localized SCLC. The costs of NSCLC ranged from €19 543 for nonsurgical stages to €30 024 for surgical stages and €24 383 for stage IV. The weight of the different components of each strategy differed markedly according to the diagnostic subgroup: the cost of diagnosis ranged from 7.4% to 14% of total management costs, and that of TC from 11.5% to 31.1%. The principal cost component was first-line chemotherapy (32–58.5%). Sensitivity analyses showed that, whatever the type of lung cancer, the percentage of actively treated patients was the main cost determinant. TC and chemotherapeutic lines also had important economic implications.

Conclusion

The model developed here enables the component costs of different lung cancer management strategies in France to be assessed and the economic consequences of new treatment modalities to be predicted.

     

Characterization of Dementia and Alzheimer’s Disease in an Older Population: Updated Incidence and Life Expectancy With and Without Dementia

Objectives. We estimated dementia incidence rates, life expectancies with and without dementia, and percentage of total life expectancy without dementia.Methods. We studied 3605 members of Group Health (Seattle, WA) aged 65 years or older who did not have dementia at enrollment to the Adult Changes in Thought study between 1994 and 2008. We estimated incidence rates of Alzheimer’s disease and dementia, as well as life expectancies with and without dementia, defined as the average number of years one is expected to live with and without dementia, and percentage of total life expectancy without dementia.Results. Dementia incidence increased through ages 85 to 89 years (74.2 cases per 1000 person-years) and 90 years or older (105 cases per 1000 person-years). Life expectancy without dementia and percentage of total life expectancy without dementia decreased with age. Life expectancy with dementia was longer in women and people with at least a college degree. Percentage of total life expectancy without dementia was greater in younger age groups, men, and those with more education.Conclusions. Efforts to delay onset of dementia, if successful, would likely benefit older adults of all ages.The number of people with dementia worldwide will rise with population aging, especially as the population of oldest adults increases. Understanding dementia risk and survival with dementia in older, community-dwelling adults is essential for health policymakers. Previous studies have produced somewhat conflicting estimates of trends in dementia and Alzheimer’s disease incidence for persons aged 85 years or older. Most studies found an increase in dementia incidence1–3 and Alzheimer’s disease incidence1,3,4 with each successive age group. However, some studies found a decrease in dementia incidence5,6 and Alzheimer’s disease incidence5 in the oldest people in the population. Others found a decrease in dementia incidence for women only4,7 or a decrease in dementia incidence8 and Alzheimer’s disease incidence7 for men only.Few studies have estimated the effect of dementia on survival of the total population, which consists of those with dementia, those who will develop dementia, and those who will not develop dementia. Life expectancy with dementia quantifies the effect of dementia on the survival of the total population. This metric is defined as the average number of years one is expected to live with dementia.9 This measure incorporates both risk of dementia incidence and expectation of life based on population-level trends rather than the trends of only those with dementia. A related measure is percentage of total life expectancy without dementia, which relates the proportion of life expectancy in a healthy state. The few studies that used these types of metrics found that older age was associated with shorter life expectancy with dementia compared with younger age and that women had a longer life expectancy with dementia than did men.9–12 These studies also found that percentage of total life expectancy without dementia decreased with increasing age and was higher among men than among women at each age.9–12Studies of dementia incidence1,8 and Alzheimer’s disease incidence1 are often limited by small sample sizes in the oldest ages and therefore combine ages 85 years and older into a single group. Studies that included more detailed age groups past 85 years had small sample sizes in these oldest age groups, which might have limited the precision and stability of incidence estimates for both dementia2,3,7 and Alzheimer’s disease.3,7 A few studies estimated life expectancy with and without dementia but primarily used cross-sectional data with prevalence estimates of dementia.10,12,13 This study design is not ideal for understanding dementia incidence and mortality in the general population, which is the information that is the most useful for informing health policy. In addition, no study, to our knowledge, has yet examined the association between educational attainment and life expectancy with and without dementia.We used data from a long-running, population-based cohort study to estimate incidence of dementia and Alzheimer’s disease, and to calculate life expectancy with and without dementia and percentage of life expectancy without dementia. We tested the following hypotheses:

• Incidence of dementia and Alzheimer’s disease increases with age.
• Life expectancy with dementia decreases with age.
• Women have a longer life expectancy with dementia than do men but a smaller percentage of total life expectancy without dementia than do men.
• Higher levels of education are related to longer life expectancy without dementia and greater percentage of total life expectancy without dementia.

     

Children’s Experiences and Awareness about Impact of Digital Media on Health

Previous research has focused on the associations between technology use and children’s health, using mainly quantitative designs. This qualitative study describes technology’s impact on physical and mental health from children’s perspectives. The differences between children’s experiences and awareness of the health-related consequences associated with digital media use were examined. Focus groups and interviews were conducted with children between the ages of 9 and 16 in nine European countries (N = 368). Results of this study indicate that children’s experiences of health-related technology impacts are different from their awareness of these impacts. Children’s direct experiences with media were less extreme in contrast to their awareness of health problems, which typically involved extreme examples of possible consequences, such as killing people, kidnapping, blindness, and developing learning or psychological disorders. The results are discussed in the context of the “media panic” and “third person effect” theories.     

Maternal emotion framing and children’s social behavior: the role of children’s feelings and beliefs about peers

Children’s feelings and beliefs about peer relationships were examined as a possible mediator between mothers’ positive and negative emotional framing and children’s (n = 46) behavior with peers. Mothers’ emotion framing was assessed as they and their young children read a picture book depicting emotionally‐laden content, but no printed text. Feelings and beliefs about self and peers were assessed during a puppet interview focusing on beliefs about self and peers. Teachers rated children’s aggressive, competent and withdrawn behavior. Mothers’ emotion framing was significantly associated with children’s cognitive representations of self and peers (r = 0.35 and ?0.44, both p < 0.01, for positive and negative emotional framing, respectively) and with withdrawn social behavior (r = ?0.39 and 0.41, p < 0.01 for positive and negative framing, respectively). Findings suggest that children’s beliefs about self and peers may mediate the association between mothers’ emotion framing and children’s withdrawn behavior.     

Men’s Controlling Behaviors and Women’s Experiences of Physical Violence in Malawi

In the feminist paradigm, intimate partner violence (IPV) among heterosexual couples is gender asymmetric and largely a tactic of male control. However, research on the relationship between men’s controlling behavior and physical violence against women is limited. This study examines whether having a controlling partner is associated with women’s reports of experiencing physical violence in Malawi. Bivariate and multivariate analyses were conducted using data from 8,385 women who completed the domestic violence module of the Malawi 2004 Demographic and Health Survey. About 18 % of women reported they had experienced moderately severe physical violence and 1 % experienced very severe violence in the past 12 months. A third of women reported their partners had ever been controlling. Results from multivariable ordinal logistic regression showed that women who had controlling partners were significantly more likely to report experiencing physical violence. Other factors significantly associated with women’s experience of physical violence included women who reported initiating physical violence against their partners, women’s work status, partners’ lower education level, and partners’ alcohol consumption. Women with controlling partners were at increased risk of experiencing physical violence in the past year. However, women who reported initiating physical violence in the past year were nearly four times more likely to experience partner violence in the same time period. Future research should attempt to elucidate these two important risk factors for IPV.     

Psychological well-being and associated factors among elderly Hansen’s Disease patients in leprosaria

Objectives We investigated psychological well-being and associated factors among elderly Hansen’s Disease (HD) patients in three national leprosaria in Japan. Methods Three questionnaires on physical and social factors, and psychological well-being based on the 12-item of General Health Questionnaire (GHQ-12) were used to survey all HD patients admitted to three leprosaria in Japan. The number of respondents over 65 years old who completed all 12 items of GHQ-12 was 754 (459 men and 295 women) with a response rate of 80.9%. Data were analyzed by t-test and analysis of covariance (ANCOVA) to determine factors associated with psychological well-being. Results The impairment in 8 physical functions, walking, eating, and toileting for both men and women, bathing for men, and vision, dressing and grooming for women, were significantly related to high GHQ-12 scores by t-test and ANCOVA. Having no close friends, less frequent contact with neighbors, and no or less frequent participation in group activities in men, and inactive daily life style in male and female HD patients, were related to high GHQ-12 scores by both analyses. Conclusion The present results showed that physical factors and inactive daily life style were related to psychological well-being for both men and women. Social factors were related to psychological well-being among elderly male HD patients in Japan. Further follow-up study is necessary to examine the causal relationships among psychological well-being and associated factors.     

Distribution of Thallium and Lead in Children’s Blood

? Mean whole blood concentrations for lead and thallium were determined by atomic absorption spectrophotometric analysis for children residing in Newark, NJ. Frequency distributions for the various concentration ranges for both metals were recorded. There is no noticeable correlation between the lead and thallium content of whole blood, which suggests that exposure to and/or absorption of these substances are different.     

A National Perspective on Exploring Correlates of Accreditation in Children’s Mental Health Care

This study is the first to explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children’s mental health. Data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC). Chi-square analyses were conducted to explore relationships. Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. Policies with incentives for accreditation could influence accreditation rates, and accreditation could influence quality indicators. These results set the foundation for future research about the drivers of the accreditation phenomenon and its impact on children’s mental health outcomes.     

Disparities in Health Insurance Coverage and Access to Care for Children By Mother’s Sexual Orientation

Maternal and Child Health Journal - Few population-based studies have examined the health care experiences of children with sexual minority parents. The purpose of this study was to compare health...