Tuberculosis in a rural population of South India: a five-year epidemiological study

Tuberculosis is a serious health problem in India, but because of inadequate facilities for diagnosis in many parts of the country clinical data are incomplete. However, data on prevalence are available from a few sample surveys conducted in the general population during the last two decades. The study reported here provides information on the incidence of infection and disease as well as on the source and fate of cases. The information was obtained by means of surveys, repeated at intervals during 1961-68 in a randomly selected rural population of South India. In each survey, a tuberculin test was given and X-ray and sputum examinations were made. There were virtually no tuberculosis control facilities in the study area, since this was not covered by the national tuberculosis programme at the time.     

Child labor in a rural Egyptian community: an epidemiological study

Objectives

Estimating the burden of child labor in a rural community of El-Minia governorate, Egypt and exploring its determinants and health impact.

Methods

One hundred and ninety nine children randomly participated from a randomly selected village; 147 (73.9 %) males and 52 (26.1 %) females, whose ages ranged from 6 to 17 years (mean age 12.1 ± 2.9). All children were subjected to interview questionnaire, and medical examination.

Results

Ninety (45.2 %) of the children reported that they are engaged in a work. The working children belonged to 65.6 and 85.6 % of illiterate fathers and mothers, respectively. The majority of the working children were engaged in jobs at quarries (58.9 %), followed by farming (21.1 %), then small proportions of children were working in other jobs. Poverty, big families and insufficient family’s income were the most frequently reported reasons for starting to work (80 %). There was a significant higher prevalence of the reported health complaints among working children.

Conclusions

Working children are at high risk of many health problems. Poverty, parents’ illiteracy, large family size and fathers’ absence are the driving force for child labor in the rural community of Eastern Minia.     

Self-selection and bias in a large prospective pregnancy cohort in Norway

Self‐selection in epidemiological studies may introduce selection bias and influence the validity of study results. To evaluate potential bias due to self‐selection in a large prospective pregnancy cohort in Norway, the authors studied differences in prevalence estimates and association measures between study participants and all women giving birth in Norway. Women who agreed to participate in the Norwegian Mother and Child Cohort Study (43.5% of invited; n = 73 579) were compared with all women giving birth in Norway (n = 398 849) using data from the population‐based Medical Birth Registry of Norway in 2000–2006. Bias in the prevalence of 23 exposure and outcome variables was measured as the ratio of relative frequencies, whereas bias in exposure‐outcome associations of eight relationships was measured as the ratio of odds ratios. Statistically significant relative differences in prevalence estimates between the cohort participants and the total population were found for all variables, except for maternal epilepsy, chronic hypertension and pre‐eclampsia. There was a strong under‐representation of the youngest women (<25 years), those living alone, mothers with more than two previous births and with previous stillbirths (relative deviation 30–45%). In addition, smokers, women with stillbirths and neonatal death were markedly under‐represented in the cohort (relative deviation 22–43%), while multivitamin and folic acid supplement users were over‐represented (relative deviation 31–43%). Despite this, no statistically relative differences in association measures were found between participants and the total population regarding the eight exposure‐outcome associations. Using data from the Medical Birth Registry of Norway, this study suggests that prevalence estimates of exposures and outcomes, but not estimates of exposure‐outcome associations are biased due to self‐selection in the Norwegian Mother and Child Cohort Study.     

AIDS knowledge and attitudes in a Turkish population: an epidemiological study

Background  

The aim of this study was to investigate and present some pertinent comments concerning Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitudes and misconceptions among the general population in a city of west Turkey. This study was deemed important and relevant due to the increasing importance of AIDS in Turkey and the other countries.     

An epidemiological study of blindness in an Indian rural community.

A house-to-house survey of blindness in an Indian rural community covering a population of 20 134 in 12 villages revealed a prevalence rate of 35 blind and 144 partially blind persons per 10 000 population. Blindness was significantly associated with the age, sex, marital status, occupation, and socioeconomic status of the respondents. Caratact, glaucoma, smallpox and trachoma were the main causes of blindness. Preventive measures can reduce the toll of blindness in such a community.     

Longitudinal epidemiological study of coronary heart disease in a rural population of Kheda district, Gujarat, India

Summary The present study was undertaken to determine the incidence and related risk factors for coronary heart diseases and hypertension in the rural population of Kheda district, Gujarat (India). The observations from the first five years of this ongoing project (May 1987–May 1992) are described in this paper. Out of an initial sample of 750 individuals in the age group 30–62 years, who were selected by stratified random sampling, 714 persons (males=429; females=285) were actually studied, after excluding those suffering from coronary heart diseases (CHD). Initially, all the included subjects were examined clinically and appropriate laboratory investigations were done. A detailed socioeconomic history was also obtained. Subsequently all of them were followed up and biannual clinical and laboratory investigations were performed. Cases of CHD were diagnosed according to the recommendations of the New York Heart Association. The overall five-year incidence of CHD was 25.17 per thousand persons. The incidence in males was 3 times higher than in females. More males suffered from myocardial infarction (MI), while in the females the incidence of sudden death was higher (33.3%). The average yearly mortality rate due to CHD was 2.46 per thousand persons. CHD was significantly associated with increased blood pressure (both diastolic and systolic), smoking, and family history of heart disease, and was weakly associated with body weight (p=0.06).

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Longitudinale epidemiologische Studie zu den Koronaren Herzkrankheiten in der ländlichen Bevölkerung des Kheda Distriktes, Gujarat, Indien

Zusammenfassung Diese Studie wurde zur Bestimmung der Inzidenz der koronaren Herzkrankheiten und des Bluthochdruckes sowie der assoziierten Risikofaktoren in der Bevölkerung des Kheda Distriktes, Gujarat, unternommen. Die vorliegende Arbeit stellt die Resultate aus den ersten fünf Jahren dieses immer noch laufenden Projektes vor. 714 Personen im Alter von 30–62 Jahren wurden studiert. Alle einbezogenen Probanden wurden klinisch und labormässig untersucht. Eine detaillierte sozio-ökonomische Anamnese wurde erhoben. In der Folge unterlagen alle Teilnehmer zweimal jährlich einer klinischen und einer labormässigen Untersuchung. Die Fälle von KHK wurden gemäss der Empfehlungen der New York Heart Association diagnostiziert. Die 5-Jahres Inzidenz der KHK lag bei 25, 17. Die Inzidenz bei den Männern war dreimal höher als diejenige der Frauen. Während die Männer vermehrt unter Herzinfarkten litten, kamen bei den Frauen plötzliche Todesfälle häufiger vor. Es bestand eine signifikante Assoziation zu erhöhten Blutdruckwerten, zum Rauchen, zu einer Familienanamnese für Herzkrankheiten und eine schwache Assoziation zum Körpergewicht.

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Les maladies cardio-vasculaires dans le district de Kheda, Gujarat, Inde: Résultats d'une étude prospective longitudinal

Résumé Une étude a été conduite dans le district Kheda (Gujarat, Inde), pour mesurer l'incidence de la maladie coronarienne, de l'hypertension artérielle et de leurs facteurs de risque. Les résultats des 5 premières années de l'étude, sont présentés ici. Un échantillon de 714 personnes de 30 à 62 ans a été selectionné par un échantillonnage aléatoire de la population à partir des listes électorales. L'échantillon étudié ont été soumises à un premier examen clinique complet, et à un interrogatoire socio-démographique. L'examen clinique sont répétés deux fois par an chez tous les sujets. Les MCV ont été diagnostiqués selon les critères de la New York Heart Association. Sur les cinq ans d'observation, l'incidence des MCV est de 25, 17 pour mille personnes, avec une incidence trois fois plus élevée chez les hommes que chez les femmes. L'incidence de l'infarctus du myocarde est plus importante chez les hommes alors que la mort subite est plus fréquente chez les femmes. La survenue d'une MCV est associée de façon significative avec une augmentation de la tension artérielle, avec le fait d'être fumeur, avec des antécédents familiaux de MCV et avec la masse corporelle ou le poids.

     

Labour insecurity and health: an epidemiological study in Zimbabwe

Existing data on health status and health care provision in agricultural labour communities in Zimbabwe indicate that both are poor. In addition, there is evidence that the concentration of capital through increased areas of landholdings, through mechanisation and use of agrochemicals produces a rise in under- and unemployment within the agricultural sector, which increases the risk of ill health. This paper addresses this question in Zimbabwe by examining the nature of developments within the large scale agricultural sector in the last decade, and the consequent effects on employment and income. Rising capital intensity in the private large scale sector is found to be associated with increases in unemployment and underemployment. The impact of this socioeconomic pattern on health is assessed in a longitudinal assessment of 78 permanent labour families and 76 non-permanent (underemployed) labour families in the large scale farming sector. The study shows that while poor social, economic and health conditions exist in all groups, non-permanent labour households suffer greater insecurity of employment and income, poorer health status and lesser participation in sociopolitical structures important for negotiating primary health care gains.     

Menopause status and attitudes in a Turkish midlife female population: an epidemiological study

Background  

It is a well accepted status that socio-cultural characteristics may affect the onset of menopause and its characteristics. The aims of this study were to describe the prevalence rates of menopausal symptoms and these symptoms related factors, and to assess the women's attitudes towards some climacteric issues.     

Prevalence of respiratory symptoms in school children and salivary IgA--an epidemiological study in a rural area of Northrhine-Westphalia,Germany

An elevated frequency of wheezing was found in school children in a rural area of Northrhine-Westphalia, Germany (Duhme and Keil, Institut für Epidemiologie und Sozialmedizin, Universit?t Münster, Münster, Germany 1997). In this study the prevalence of wheezing was reinvestigated by including main influencing factors. A cross-sectional survey was performed in all school children visiting school classes 1, 2 and 7, 8 (n = 1161). Two corresponding questionnaires were used: a parental questionnaire and a questionnaire for self-completion by the children aged 12-15. The latter included the ISAAC video questionnaire. The levels of immunoglobulins A, G and M were determined in 995 saliva samples. Testing of lung function (whole body plethysmography before and after physical exercise) was performed in children with and without parent-reported wheezing in the last 12 months (n = 377). Response rate (questionnaire: 93%) and participation rates (saliva samples: 86%, lung function tests: 93%) were high. Our study confirmed higher prevalence of asthmatic symptoms in children aged 6-8 in Ochtrup (13.2%) compared to children of the same age in Muenster (8.5% (Duhme et al., Eur. Respir. J. 11, 840-847, 1998)). However, in the age group 12-15 years the prevalence was significantly lower in Ochtrup (9.8%), when compared to the former investigation and in comparison to Muenster (former survey: 17.9%; Muenster: 13.1%). Prevalence of wheezing was consistently higher in families with atopic disease. Additionally, history of respiratory disease, premature birth and presence of pets during 1st year of life showed a positive association with prevalence of wheezing. Mean salivary IgA levels were 61.4 (SD (standard deviation) 35.1, median: 53.7) mg/l in children aged 6-8 years and 83.4 (SD 39.0, median: 76.3) mg/l in children aged 12-15 years. No significant association between salivary immunoglobulins and wheezing was detected.     

Determinants of self-rated health in a representative sample of a rural population: a cross-sectional study in Greece

Self-rated health (SRH) is a health measure related to future health, mortality, healthcare services utilization and quality of life. Various sociodemographic, health and lifestyle determinants of SRH have been identified in different populations. The aim of this study is to extend SRH literature in the Greek population. This is a cross-sectional study conducted in rural communities between 2001 and 2003. Interviews eliciting basic demographic, health-related and lifestyle information (smoking, physical activity, diet, quality of sleep and religiosity) were conducted. The sample consisted of 1,519 participants, representative of the rural population of Tripoli. Multinomial regression analysis was conducted to identify putative SRH determinants. Among the 1,519 participants, 489 (32.2%), 790 (52%) and 237 (15.6%) rated their health as "very good", "good" and "poor" respectively. Female gender, older age, lower level of education and impaired health were all associated with worse SRH, accounting for 16.6% of SRH variance. Regular exercise, healthier diet, better sleep quality and better adherence to religious habits were related with better health ratings, after adjusting for sociodemographic and health-related factors. BMI and smoking did not reach significance while exercise and physical activity exhibited significant correlations but not consistently across SRH categories. Our results support previous findings indicating that people following a more proactive lifestyle pattern tend to rate their health better. The role of stress-related neuroendocrinologic mechanisms on SRH and health in general is also discussed.     

Geographic distribution of need and access to health care in rural population: an ecological study in Iran

Introduction  

Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009.     

Chronic illness among children in a total population. An epidemiological study in a Swedish primary health care district

The prevalence of chronic illness of all 6,080 0-15-year-old children in a defined geographical area in southern Sweden was studied. Information on the health status of the children was obtained from health and medical records, interviews with the district and school nurses and questionnaires to the parents. Chronic illness was defined as a disability interfering with normal life and/or demanding treatment for at least three months during the year 1981 and was revealed in 510 children corresponding to the period prevalence 84/1,000 with 95% confidence interval (CI) 60-108/1,000. Boys predominated. 131 children suffered from more than one disease. Chronic illness caused severe disability in 40 children, moderate in 113 and mild in 357 children. Atopic disorders were the leading cause of chronic illness (34/1,000 with 95% CI 29-39/1,000). Mental and nervous system disorders and congenital malformations were the most frequent causes of severe disability. Prevalence figures for the different diagnoses in relation to disability level, sex and age are presented.     

Attrition and bias in the MRC cognitive function and ageing study: an epidemiological investigation

Background  

Any hypothesis in longitudinal studies may be affected by attrition and poor response rates. The MRC Cognitive Function and Ageing study (MRC CFAS) is a population based longitudinal study in five centres with identical methodology in England and Wales each recruiting approximately 2,500 individuals. This paper aims to identify potential biases in the two-year follow-up interviews.     

辉县市农村人群伤害死亡的流行病学分析

目的 分析辉县市农村人群伤害死亡的死因特点，评价该人群伤害死亡的危害程度。方法 计算伤害死亡率、YPLL、YPLL率、WYPLL和WYPLL率等指标，对辉县市农村人群伤害死因进行分析。结果 1997～2001年辉县市农村人群的平均伤害标化死亡率为70．27／10万，男性高于女性；占总死因构成的9．65％，死因顺位居第四位；伤害死亡的标化YPLL率为21．60％，占全部YPLL的30．41％；标化WYPLL率为17．20‰，占全部WYPLL的34．56％，YPLL和WYPLL占总死亡的比重分别比全国水平高23．62％和30．42％，死因顺位高居第一。死亡率、YPLL率和WYPLL率均以交通事故、自杀、淹死、意外跌落居前四位。结论 伤害不仅成为严重危害辉县市农村人群生命健康的主要问题，而且也是造成当地劳动力人群YPLL和WYPLL的主要原因。     

Publication bias in epidemiological studies

Communication of research findings is the utmost responsibility of all scientists. Publication bias occurs if scientific studies with negative or null results fail to get published. This can happen due to bias in submitting, reviewing, accepting, publishing or aggregating scientific literature that fails to show positive results on a particular topic. Publication bias can make scientific literature unrepresentative of the actual research studies. This can give the reader a false impression about the beneficial effects of a particular treatment or intervention and can influence clinical decision making. Publication bias is more common than it is actually considered to be, but there are ways to detect and prevent it. This paper comments on the occurrence, types and consequences of publication bias and the strategies employed to detect and control it.     

An epidemiological study of the respiratory health of workers in the European refractory ceramic fibre industry

OBJECTIVES—To investigate possible relations between respiratory health and past airborne exposure to refractory ceramic fibres (RCFs) and respirable dust in workers at six European factories, studied previously in 1987.
METHODS—The target population comprised all current workers associated with RCF production, plus others who had participated in 1987 "leavers". Information was collected on personal characteristics, chest radiographs, lung function, respiratory symptoms, smoking, and full occupational history. Regression analysis was used to study relations between indices of health of individual workers and of cumulative exposure to airborne dust and fibres, and likely past exposure to asbestos.
RESULTS AND DISCUSSION—774 workers participated (90% of current workers, 37% of leavers). Profusion of small opacities in exposed workers (51% 0/1+; 8% 1/0+) was similar to that among an unexposed control group but higher than in new readings of the 1987 study films (11% 0/1+, 2% 1/0+). The large difference between 1987 and recent films may be, at least in part, a reading artefact associated with film appearance. Small opacities of International Labour Organisation (ILO) category 1/0+ were not associated with exposure. An association of borderline significance overall between 0/1+ opacities and exposure to respirable fibres was found for some exposure periods only, the time related pattern being biologically implausible. Pleural changes were related to age and exposure to asbestos, and findings were consistent with an effect of time since first exposure to RCFs. Among men, forced expired volume in 1 second (FEV₁) and forced vital capacity (FVC) were inversely related to exposure to fibres, in current smokers only. FEV₁/ FVC ratio and transfer factor (TL_CO) were not related to exposures. The estimated restrictive effect was on average mild. Prevalence of respiratory symptoms was low. Chronic bronchitis and its associated symptoms (cough, phlegm) showed some association with recent exposure to respirable fibres. This could be due to an irritant effect of RCFs.


Keywords: respiratory health; ceramic fibres     

A study of health and health related social problems in the geriatric population in a rural area of Tamil Nadu.

About 200 individuals aged 60 years and above, out of 317 total geriatric population of a small village in Tamil Nadu were subjected for complete clinical examinations with the objective of finding major health problems and associated social problems prevalent among these study population. Main causes of illness were found to be arthritis, cataract, bronchitis, skin diseases and malnutrition.     

Self-selection and moral hazard in Chilean health insurance

We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.