Cholera epidemic in Senegal in 1995-1996: an example of geographic approach to health

There have been many cholera outbreaks in Senegal since 1971. The last outbreak began in the Dakar region in August 1995. It spread to the Diourbel, Fatick, Saint-Louis and Thies regions. In January 1996, the outbreak hit the Niakhar study area in the Fatick region. A team from ORSTOM (the French Institute of Scientific Research for Development in Cooperation) has been recording demographic events in this area for almost 15 years. The geographic approach is based on the automated mapping of cholera in hamlets and villages. Such studies investigate the factors determining the spread of diseases, within the context of land use. Three sets of data were used: demographic data that had been routinely collected and were available from a database, digitized maps and epidemiological data from a surveillance system set up to monitor the outbreak. A series of incidence maps, over time and on various scales, were generated using specialized software. The maps were analyzed and the outbreak was found to be heterogeneous over time. There were two waves of the outbreak and differences according to age and gender. The degree of heterogeneity depended on the place of residence. Heterogeneity was probably determined by village size, roads and the concentration of inhabitants within hamlets, which is roughly equivalent to the number of people per bore hole. These preliminary results suggest that further research is necessary, looking at different geographical scales (e.g. households, districts and regions). Qualitative studies of water use and the organization of the water supply are also required.     

Persistence of health habits and their relationship to mortality

This paper explores the relationship of seven personal health practices and subsequent mortality in the $\text{9}\text{1}\text{2}$ years between an initial survey of 6,928 adults made in Alameda County, California, in 1965 and a follow-up survey in 1974. The seven health practices are: never smoking cigarettes, regular physical activity, moderate or no use of alcohol, 7–8 hr sleep/day regularly, maintaining proper weight, eating breakfast, and not eating between meals. When accumulated to form a health practice score from 0 to 7, the number of health practices showed a striking inverse relationship with age-adjusted mortality rates, especially for men. Men following seven health practices had a mortality rate only 28% that of men following zero to three health practices. Women following seven health practices had a mortality rate 43% that of women following zero to three health practices. Both the health practices themselves and their relationship to mortality are shown to be reasonably stable over the $\text{9}\text{1}\text{2}$-year period of follow-up. These results lend support to the hypothesis that good health practices and not the initial health status of the survey respondents are largely responsible for the observed mortality relationships. These and other methodological issues are explored.     

Spatial analysis of early neonatal mortality in the municipality of Rio de Janeiro, 1995-1996]

The objective of this study was to establish the spatial distribution of the early neonatal mortality rate (0-3 days) in the municipality of Rio de Janeiro for 1995-1996, identifying the best explanatory factors for spatial variations. By considering Rio de Janeiro's 153 neighborhoods as ecological units of analysis, socioeconomic and maternal indicators were analyzed according to place of residence. Spatial statistical analysis was performed using the Cliff & Ord methodology, appropriate for lattice data. From the 0-3 day mortality thematic map, we clearly identified two clusters of high early neonatal mortality rates. Spatial dependence was also confirmed by the statistical results of the spatial analysis. The variables that explain the clusters are the proportions of "adolescent mothers", "slum-dwellers", and "heads of households below the poverty level". Spatial statistics provided a better understanding of the geographic distribution of early neonatal mortality and suggested potential hypotheses for further investigation, which could support preventive programs and contribute to a decrease in infant mortality.     

An assessment of occupational health care in the Netherlands (1996-2005)

BACKGROUND: The extensive Dutch occupational health care system of the past decade has not led to the desired outcomes, namely, a decrease of work absenteeism and the associated costs. AIM: To assess the differences between in-house and external occupational health care services in the process quality of occupational health care provided. METHODS: In total, 26 interviews were conducted with chief executive officers of occupational health services (OHS). The responses and other relevant policy documents were analysed and described. A key component of this process was to compare differences between in-house and external services. RESULTS: Notable differences in quality were found to exist between in-house and external occupational health care systems, with the in-house occupational health care services offering the highest process quality. CONCLUSION: Our findings suggest that the effectiveness of OHS is mainly dependent on their structure (in-house versus external) and on economic factors (profit driven versus not for profit).     

The Boston Puerto Rican Health Study,a longitudinal cohort study on health disparities in Puerto Rican adults: challenges and opportunities

Background  

The Boston Puerto Rican Health Study is an ongoing longitudinal cohort study designed to examine the role of psychosocial stress on presence and development of allostatic load and health outcomes in Puerto Ricans, and potential modification by nutritional status, genetic variation, and social support.     

The nutritional impact of dairy product consumption on dietary intakes of adults (1995-1996): the Bogalusa Heart Study

OBJECTIVE: To examine the nutritional impact of dairy product consumption on the dietary intakes of adults. DESIGN: Dietary intakes of adults who participated in a cross-sectional survey (1995-1996) in Bogalusa, LA. SUBJECTS: Dietary intake data were collected on 1,266 adults (61% women, 39% men; 74% white, 26% African American) in Bogalusa, LA. STATISTICAL ANALYSIS: Analysis of covariance was used to examine the mean nutrient intake differences among four dairy consumption groups. Significance tests in multiple comparisons between any two groups were conducted using Tukey's procedure. RESULTS: Forty-eight percent of adults consumed one serving or less of dairy products, 32% consumed two servings, 12% consumed three servings, and 8% consumed four or more servings. Overall mean intake of dairy was higher in whites (mean=1.63) compared with African Americans (mean=1.22) (P<.0001), especially the consumption of milk and cheese. No differences were found in overall mean intake of dairy servings by sex after adjusting for energy intake. However, women consumed significantly more servings of cheese (P<.0001) and yogurt (P<.01) than men. There were higher intakes of total energy, saturated fat, total protein, animal protein, and lactose (P<.0001), with greater number of servings of dairy products consumed. There were lower intakes of monounsaturated and polyunsaturated fatty acids (P<.0001), vegetable protein (P<.0001), total carbohydrates (P<.01), sucrose (P<.001), fructose (P<.0001), and fiber (P<.001). The percentage of energy from saturated fat (P<.0001) and protein (P<.001) increased with increasing number of dairy servings consumed. Intakes of calcium; magnesium; potassium; zinc; sodium; folate; thiamin; riboflavin; and vitamins B-6, B-12, A, D, and E were higher with greater number of dairy servings consumed. There was lower consumption of sweetened beverages (P<.001), specifically regular soft drinks (P<.0001), with greater consumption of milk products. CONCLUSIONS: Dairy product consumption by adults has a major influence on their vitamin and mineral intakes. The higher intakes of saturated fat, total energy, and animal protein and lower intake of fiber suggest that it may be useful to consume lower-fat dairy products and/or modify eating patterns to optimize the nutritional contributions of dairy products. Public health organizations and dietetics professionals need to educate adults on practical strategies for increasing dairy product consumption for improving the nutritional quality of adults' diets.     

Modeling trends of health and health related indicators in Ethiopia (1995-2008): a time-series study

Background  

The Federal Ministry of Health of Ethiopia has been publishing Health and Health related indicators of the country annually since 1987 E.C. These indicators have been of high importance in indicating the status of health in the country in those years. However, the trends/patterns of these indicators and the factors related to the trends have not yet been investigated in a systematic manner. In addition, there were minimal efforts to develop a model for predicting future values of Health and Health related indicators based on the current trend.     

Private health insurance in Portugal: a comparative analysis of the National Health Surveys, 1995-1996 and 1998-1999

The National Health Survey (NHS) has been used to calculate the percentage of the population with private health insurance at both the nationwide and regional levels. Schooling and occupation have been used as proxies for income level in calculating the percentage of the population with private health insurance. The impact of chronic diseases has also been analyzed in relation to the purchase of private health insurance. A comparative analysis of the NHS from 1995-1996 to 1998-1999 showed an increase of 1% and 0.7% (for males and females, respectively) in the proportion of the population with health insurance. Level of income shows a clear inf1uence on the acquisition of private health insurance. Individuals with medium and high levels of schooling, both males and females, are far more likely to have private insurance. Chronic diseases also have an impact on the purchase of private health insurance. According to regional analysis of NHS 1998-1999, the Greater Lisbon Metropolitan Area showed a higher percentage than the nation as a whole.     

The financial performance of community health centers, 1996-1999

This paper presents recent financial health trends of community health centers (CHCs) between 1996 and 1999, a time characterized by fiscal and operating challenges. Results show that many individual CHCs have been subject to large changes in payer-mix among uninsured and Medicaid users. Troubling is the finding that more than half of all CHCs reported operating deficits in 1997, 1998 and 1999. CHCs experiencing large increases in the share of uninsured users and those participating in Medicaid managed care appear to have been disproportionately affected. The analyses presented support recommendations for enhanced data collection and for further monitoring of CHCs' financial health.     

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996

Background: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. Patients and methods: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. Results: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8–24.5) in 1992, and 16% (95% CI: 13.8–18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8–20.7) and (OR: 10; 95% CI: 6–16.5), weekend admission (OR: 2; 95% CI: 1.3–1.2) and (OR: 2; 95% CI: 1.2–2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3–29.6), and 13.5% (95% CI: 12.7–14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on week-days (OR: 1.4; 95% CI: 1.2–1.8) and (OR: 0.6; 95% CI: 0.5–0.8) and length of stay (OR: 2; 95% CI: 1.8–2.4) and (OR: 2.4; 95% CI: 2.3–2.5), for 1992 and 1996 respectively, among other variables. Conclusion: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.     

The use of anxiolytic and hypnotic drugs in Spain (1995-2002)

BACKGROUND: Recent studies have revealed a rise in the use of anxiolytic and hypnotic drugs as well as the improper use thereof in Western countries. This study is aimed at ascertaining the pattern of use of anxiolytic and hypnotic drugs in Spain within the 1995-2002 period. METHODS: The data related to the use of medications was taken from the Ministry of Health and Consumer Affairs' ECOM (Medicinal Products Consumption) database, which includes information on the use of medications delivered through the community pharmacies and reimbursed by the National Health System. The data are expressed in Defined Daily Doses per 1,000 inhabitants per day. RESULTS: The use of anxiolytic and hypnotic drugs rose from 39.71 Defined Daily Doses per 1,000 inhabitants per day in 1995 to 62.02 in 2002. Throughout the period under study, benzodiazepines having a medium-range half-life (8-24 h.) were those most used, especially lorazepam, alprazolam and lormetazepam. The active ingredient having shown the greatest drop in use was flunitrazepam. CONCLUSIONS: Although the use of anxiolytic and hypnotic drugs has undergone a considerable rise in recent years in Spain, the pattern of use has shown no major changes.     

Competitiveness in the health care sector: analysis of the Swedish reform (1992-1995)

The paper reviews the outcomes and failures of the Swedish health care reform, as well as the lessons learned for accomplishing better financial results and quality standards.     

Some emotional repercussions of adolescent pregnancy in Rio de Janeiro, Brazil (1999-2001)

This study analyzed the association between early pregnancy and negative emotional repercussions for adolescents, according to socio-demographic and psychosocial variables. The study interviewed 1,228 adolescents in maternity hospitals in the City of Rio de Janeiro. Emotional repercussions were evaluated with negative self-assessment variables, showing little or no expectation towards the future, as well as psychological distress. The chi2 test and odds ratio were used to analyze the data. Adolescents who reported a negative reaction by the family felt less valued (OR 1.8), with little expectation towards the future (OR 2.3), and presented major psychological distress (OR 1.5). Those not enrolled in school when they became pregnant also showed worse self-esteem (OR 1.9) and fewer expectations towards the future (OR 2.2). Greater psychological distress was inversely related to frequency of prenatal care (0.7). The article concludes that family support, regardless of original social conditions, was identified as the principal factor for minimizing negative emotional repercussions of pregnancy during adolescence.     

Health-associated changes in drinking: a period prevalence study of the Atherosclerosis Risk In Communities (ARIC) cohort (1987-1995)

BACKGROUND: Several investigators have suggested that drinking cessation occurs because of poor health which may bias studies on the benefit or risk of alcohol consumption. METHODS: Drinking status, level of alcohol consumption, and two measures of health (perceived health and physician diagnosed chronic disease status) were determined from exams 1 (1987-1989) and 3 (1993-1995) on 12,562 African- and European-American participants, who were aged 45-64 years at exam 1 in the ARIC Study. For those in good health at exam 1, logistic regression analyses were used to model the association between health decline and drinking change at exam 3. RESULTS: Among the total population, drinking cessation was significantly more common among those who reported poor health at exam 3, and nondrinkers were unlikely to begin drinking regardless of exam 3 health. Using different measures of health status resulted in associations whose strength and significance varied with ethnicity and, in some cases, by gender. CONCLUSION: While the current data do not prove that the health decline occurred prior to drinking cessation, our findings support the hypothesis that poor health results in drinking changes which could potentially bias studies of alcohol's benefit and risk even when lifetime abstainers are used as the reference group.     

The main problems of occupational health in Navarra, 1994-1996

In 1996 the Navarra Occupational Health Institute, an autonomous technical organization that integrates the functions and means related to occupational health matters, drew up the Occupational Health Diagnosis of Navarra, which is a region characterised by its important industrial sector and its high proportion of small and medium size companies. The results emphasise the high accident rate in the construction sector, the constant increase of professional diseases through "fatigue of tendon pods", as well as the importance of osteo-muscular processes as a cause of temporary and permanent disability. Forty sentinel occupational tumors, mainly mesothelioma, and 27 Obligatory Statement Diseases of occupational origin, mainly brucellosis, were identified in a period of seven years and three years, respectively. Verification was made of a lack of systematised information about population exposure to occupational risks, a scarce development of medical surveillance of exposed workers, and a lack of information about the incidence of occupational injuries in self-employed workers.