社区老年人社会经济地位与轻度认知功能障碍的相关性研究

目的  探讨老年人社会经济地位(socioeconomic status,SES)与轻度认知功能障碍(mild cognitive impairment,MCI)患病的关联。方法  数据来源于湖北老年记忆队列(the Hubei Memory and Aging Cohort Study,HMACS);共纳入7 887名≥65岁老年人,他们完成了3全套神经心理评估和临床体格检查。SES通过受教育程度、职业性质和家庭人均月收入综合评定;MCI由专家组根据Petersen标准和中国痴呆与认知障碍诊治指南进行诊断;多因素logistic回归分析模型分析老年人SES与MCI患病的关联。结果  共纳入7 887名调查对象,平均年龄(71.74±5.58)岁,MCI检出率为23.00%(95% CI: 22.07%~23.93%);低SES组MCI检出率(44.65%)高于中SES组MCI检出率(16.89%)和高SES组MCI检出率(9.18%);女性高于男性;农村高于城市。分层分析发现：城市男性低SES组MCI患病风险为高SES组的6.276倍(OR=6.276, 95% CI: 4.017~9.805),城市女性低SES组MCI患病风险为高SES组的3.978倍(OR=3.978, 95% CI: 2.943~5.376);依据现有SES标准,农村女性老年人SES分布不均匀。结论  低SES组老年人MCI检出率较高,认知功能障碍的防控要密切关注低SES组老年人,特别是社区低收入、低教育程度的老年人。     

Family structure, socioeconomic status, and access to health care for children

OBJECTIVE: To test the hypothesis that among children of lower socioeconomic status (SES), children of single mothers would have relatively worse access to care than children in two-parent families, but there would be no access difference by family structure among children in higher SES families. DATA SOURCES: The National Health Interview Surveys of 1993-95, including 63,054 children. STUDY DESIGN: Logistic regression was used to examine the relationship between the child's family structure (single-mother or two-parent family) and three measures of health care access and utilization: having no physician visits in the past year, having no usual source of health care, and having unmet health care needs. To examine how these relationships varied at different levels of SES, the models were stratified on maternal education level as the SES variable. The stratified models adjusted for maternal employment, child's health status, race and ethnicity, and child's age. Models were fit to examine the additional effects of health insurance coverage on the relationships between family structure, access to care, and SES. PRINCIPAL FINDINGS: Children of single mothers, compared with children living with two parents, were as likely to have had no physician visit in the past year; were slightly more likely to have no usual source of health care; and were more likely to have an unmet health care need. These relationships differed by mother's education. As expected, children of single mothers had similar access to care as children in two-parent families at high levels of maternal education, for the access measures of no physician visits in the past year and no usual source of care. However, at low levels of maternal education, children of single mothers appeared to have better access to care than children in two-parent families. Once health insurance was added to adjusted models, there was no significant socioeconomic variation in the relationships between family structure and physician visits or usual source of care, and there were no significant disparities by family structure at the highest levels of maternal education. There were no family structure differences in unmet needs at low maternal education, whereas children of single mothers had more unmet needs at high levels of maternal education, even after adjustment for insurance coverage. CONCLUSIONS: At high levels of maternal education, family structure did not influence physician visits or having a usual source of care, as expected. However, at low levels of maternal education, single mothers appeared to be better at accessing care for their children. Health insurance coverage explained some of the access differences by family structure. Medicaid is important for children of single mothers, but children in two-parent families whose mothers are less educated do not always have access to that resource. Public health insurance coverage is critical to ensure adequate health care access and utilization among children of less educated mothers, regardless of family structure.     

Health policies and the relationships between socioeconomic status,access to health care,and health

Health policies tend to focus on improving the access to health care of persons of low-socioeconomic status to improve their health. This commentary argues that health policies directly directed at health and socioeconomic status (and other components of individual welfare) will also be effective if one wants to improve the well-being of the poor.     

Variations in health status within and between socioeconomic strata

Objectives: To analyse the variability in health status within as well as between socioeconomic groups. What is the range of individual variability in the health effects of socioeconomic status? Is the adverse effect of lower socioeconomic status uniform across the entire distribution of health status? Design: Nationally representative telephone survey of the US population in 1996. Setting: 60 US metropolitan and rural areas. Participants: 47 076 adult respondents to the community tracking study. Main outcome measures: Self rated physical and mental health status, measured by the Short Form-12 instrument. Results: There is considerable variability in self rated health within socioeconomic strata and that variability increases in a step-wise fashion at each lower stratum of income. Most of the increased variability is accounted for by changes in the middle and lower (10th, 25th, and 50th centiles) rather than the upper (75th and 90th) portions of the distribution. A resilient subgroup of lower socioeconomic status people seems to maintain excellent self rated health throughout life, while a more vulnerable lower socioeconomic status group experiences rapid deterioration in health status as people reach middle age. Conclusions: Within the population level social structuring of health there are differences in individual resilience and vulnerability that are amenable to further exploration and potential modification.     

Pro-cyclical mortality across socioeconomic groups and health status

Using variation across geographic regions, a number of studies from the U.S. and other developed countries have found more deaths in economic upturns and less deaths in economic downturns. We use data from regions in Norway for 1977–2008 and find the same pro-cyclical patterns. Using individual-level register data for the identical population, we find that disadvantaged socioeconomic groups are not hit harder by pro-cyclical mortality than advantaged groups. We also find that other indicators of deteriorated health (than death), like becoming disabled, are pro-cyclical. Overall, our analysis suggests that pro-cyclical mortality is rather related to deaths of people already in deteriorated health than to people of low socioeconomic status.     

Time perspective and socioeconomic status: A link to socioeconomic disparities in health?

Time perspective is a measure of the degree to which one's thinking is motivated by considerations of the future, present, or past. Time perspective has been proposed as a potential mediator of socioeconomic disparities in health because it has been associated with health behaviors and is presumed to vary with socioeconomic status. In this cross-sectional community-based survey of respondents recruited from hair salons and barber shops in a suburb of Washington DC, we examined the association between time perspective and both education level and occupation. We asked participants (N = 525) to complete a questionnaire that included three subscales (future, present-fatalistic, and present-hedonistic) of the Zimbardo Time Perspective Inventory. Participants with more formal education and those with professional occupations had higher scores on the future time perspective subscale, and lower scores on the present-fatalistic subscale, than participants with less formal education or a non-professional occupation. Present-fatalistic scores were also higher among participants whose parents had less formal education. Present-hedonistic scores were not associated with either education level or professional occupation. Time perspective scores were not independently associated with the likelihood of obesity, smoking, or exercise. In this community sample, future time perspective was associated with current socioeconomic status, and past-fatalistic time perspective was associated with both current and childhood socioeconomic status.     

社区老年人健康状况及卫生服务调查

目的对社区老年人的健康状况以及卫生服务情况进行调查。方法 2010年6月随机抽查广州市社区所属居委中的南园东居委340户家庭个人档案,调查分析该居委60岁以上老年人健康状况。结果慢性病患者69.06%,慢性病患病率排在前五位的是高血压、白内障、冠心病、慢性支气管炎及慢性阻塞性肺疾病、糖尿病。吸烟、高盐饮食是高血压发病的危险因素,参加体育锻炼可以有效降低冠心病、糖尿病的发病率。结论以预防保健为基础,大力开展社区卫生服务,是解决老年人卫生问题的主要途径。     

以妇幼保健为重点推进社区卫生服务的发展

海珠区妇幼保健院在领导的重视下，积极成立社区卫生服务站，转变观念，利用自身优势，在原有的保健工作基础上，广泛开展健康促进活动，将保健保偿纳入社区卫生服务中，拓宽服务项目，开展以妇幼保健为重点的社区卫生服务，取得一定成效，实践证明，以妇幼保健为重点，做好社区妇幼保健工作，有利于推进社区卫生服务的全面发展。     

The public health impact of socioeconomic status on adolescent depression and obesity

OBJECTIVES: We examined the public health impact of the socioeconomic status (SES) gradient on adolescents' physical and mental health. METHODS: Population attributable risk (PAR) for household income and parental education were calculated relative to depression and obesity among a nationally representative sample of 15,112 adolescents. RESULTS: PARs for income and education were large. Across each gender and race/ethnicity group, the PAR for education tended to exceed that for income. For depression, the adjusted PAR for income was 26%, and the PAR for education was 40%; for obesity, the adjusted PAR for income was 32%, and the PAR for education was 39%. CONCLUSIONS: SES is associated with a large proportion of the disease burden within the total population.     

Understanding health disparities: the role of race and socioeconomic status in children's health

OBJECTIVES: We sought to determine whether childhood health disparities are best understood as effects of race, socioeconomic status (SES), or synergistic effects of the two. METHODS: Data from the National Health Interview Survey 1994 of US children aged 0 to 18 years (n=33911) were used. SES was measured as parental education. Child health measures included overall health, limitations, and chronic and acute childhood conditions. RESULTS: For overall health, activity and school limitations, and chronic circulatory conditions, the likelihood of poor outcomes increased as parental education decreased. These relationships were stronger among White and Black children, and weaker or nonexistent among Hispanic and Asian children. However, Hispanic and Asian children exhibited an opposite relationship for acute respiratory illness, whereby children with more educated parents had higher rates of illness. CONCLUSIONS: The traditional finding of fewer years of parent education being associated with poorer health in offspring is most prominent among White and Black children and least evident among Hispanic and Asian children. These findings suggest that lifestyle characteristics (e.g., cultural norms for health behaviors) of low-SES Hispanic and Asian children may buffer them from health problems. Future interventions that seek to bolster these characteristics among other low-SES children may be important for reducing childhood health disparities.     

The effects of socioeconomic status,perceived discrimination and mastery on health status in a youth cohort

This study examined the influence of socioeconomic status, perceived discrimination, and sense of mastery over one's life on the health status of a sub-sample of a US cohort of youth (N = 969). When controlling for a variety of social characteristics and personal attributes, only sense of mastery over one's life, measured by the Pearlin Mastery Scale, affected physical and mental health statuses. Perceived discrimination affected only mental health status, while SES over the life course affected only physical health. Findings affirmed the efforts of professions like social work that stress self-determination and empowerment enabling individuals to enhance their own social functioning and improve conditions in their communities and in society at large. They also suggested that in regard to mental health advocacy efforts to decrease health disparities can find social justice related grounds based on gender.     

Gender differences in the relationship between housing, socioeconomic status, and self-reported health status

This study investigates gender differences in housing, socioeconomic status, and self-reported health status. The analysis focuses on the social and economic dimensions of housing, such as demand, control, material aspects (affordability, type of dwelling) and meaningful aspects (pride in dwelling, home as a refuge) of everyday life in the domestic environment. A random sample, cross-sectional telephone survey was administered in the city of Vancouver, Canada in June 1999 (n = 650). Survey items included measures of material and meaningful dimensions of housing, housing satisfaction, and standard measures of socioeconomic status and social support. The main outcome measure was self-reported health (excellent/very good/good vs. fair/poor). A three-stage analysis provides an overall picture of the sample characteristics for male and female respondents, detects significant relations between individual and housing characteristics and self-rated health status, and investigates male-female differences in the factors associated with fair/poor self-rated health. In multivariate analyses, a small number of socioeconomic dimensions of housing were associated with self-rated health status for women. For men, only one attribute of housing was associated with self-rated health: crowding was positively related to poor health, contradicting expectations and the findings for women. The self-reported strain of housework was unrelated to self-rated health for men, but strongly related to poor health for women. For men and women, satisfaction with social activities increased the likelihood of reporting better health. Future research should focus on the health effects of gendered differences in domestic and paid work, and on home and family roles and the interaction among gender, household crowding, and health.     

妊娠期妇女健康现状调查及影响因素分析

目的:调查分析妊娠期合并症的相关影响因素,为围产期保健提供有效依据,为社区医疗和医院卫生服务模式提出合理化建议。方法:现场问卷调查,EpiData3.02和SPSS12.0软件对数据进行统计分析。结果:被调查的妊娠期妇女在妊娠期间无吸烟、饮酒者,大多数人均能偶尔锻炼身体。饮食、孕期体重增加和BMI是妊娠期高血压疾病的影响因素(P<0.05),年龄、孕期体重增加是妊娠期糖尿病的影响因素(P<0.05)。结论:①妊娠期妇女妊娠年龄后移,妊娠期妇女孕期体重增加幅度较大。②妊娠期妇女健康状况不容乐观。③饮食偏咸、体型肥胖和孕期体重增加过多是妊娠期高血压疾病的高危因素;年龄、孕期体重增加过多是妊娠期糖尿病的高危因素。④妊娠期妇女参保率低,社区卫生服务现状堪忧。     

Subjective social status in association with various health and socioeconomic indicators in Tehran

Aim

Socioeconomic status (SES) is one of the most important determinants of health. Subjective social status (SSS) is a popular SES indicator. The objective of this study is to compare the associations between health and various SES indicators in order to examine whether SSS is a proper SES indicator.

Subject and methods

In this 2013 cross-sectional study, 1,995 Tehrani residents were selected through multi-stage random sampling. The questionnaires included items on subjective and objective SES, self-rated health (SRH) and objective health status. The crude and adjusted associations between health and SES indicators were assessed using bivariate and multiple logistic regressions.

Results

The crude associations between SSS and all assessed health outcomes were significant. After adjustment of the wealth index, consumption, education and occupation, the associations between SSS and SRH (OR?=?0.69, CI 95 %: 0.55–0.86) and having cardiovascular (OR?=?0.73, CI 95 %: 0.58–0.92), musculoskeletal (OR?=?0.81, CI 95 %: 0.70–0.94), asthma and other respiratory diseases (OR?=?0.71, CI 95 %: 0.54–0.92) still remained significant. The adjusted associations between SSS and having hypertension and diabetes were not significant. SSS had a stronger correlation with the wealth index (Spearman r?=?0.42) compared to other SES indicators.

Conclusion

SSS showed a significant association with most of the health outcomes, independent of other SES indicators; therefore, it can be used in health research, though it is not an exact alternative for other objective SES indicators.

     

Physical examination status of children and adolescents in distinct health plans.

In this study, the relative effect of plan membership—fee-for-service and prepaid group—on the physical examination status of children and adolescents is investigated. The primary concern is to evaluate the impact of plan membership on the occurrence and rationale for the physical examination. A related interest is to explore the relationships between sociodemographic characteristics and physical examination status of respondents. The results of analysis show that, for the sample as a whole, plan membership and the other explanatory variables had significant effects on both the occurrence and reason for the physical examination. In the analysis by plan, race was not explanatory. Only age and sex were significant in explaining differences in reasons given by respondents in the fee-for-service plan while all of the factors except race were significant for those in the prepaid group practice. Overall, there appears to be a prepaid group advantage in both the occurrence and giving of a preventive reason for the physical examination. This is thought to be tied to plan coverage. It is suggested that this type of practical consideration be reflected in research on use of preventive services.     

江西省城市社区卫生服务站卫生人员情况调查

目的 了解2010年江西省城市社区卫生服务站的卫生人员情况,为提高社区卫生服务站卫生人员素质提供参考依据.方法 采用普查法对2010年江西省390家社区卫生服务站的卫生人员进行调查.结果 江西省城市社区卫生服务站共有卫生人员3 572人,其中卫生技术人员3 132人,占87.68％.在卫生技术人员中医师人员最多,占35.97％,护士次之,占34.57％;卫生技术人员学历以中专(39.22％)和大专(30.91％)为主,职称以初级职称(41.63％)和中级职称(26.68％)为主.结论 江西省城市社区卫生服务站医护比例不甚合理,有待合理配置;卫生人员整体素质相对偏低,有待于进一步提高.     

UHPP项目社区卫生服务机构发展状况分析

目的了解中英城市卫生服务与贫困医疗救助(UHPP)项目的社区卫生服务机构发展状况。方法采用分层抽样方法,在沈阳和成都共抽取13个社区卫生服务机构(CHS)。用定量和定性相结合的调查方法,对2001年～2004年间机构各方面发展状况进行调查分析。结果与2001年比较,UHPP项目的社区卫生服务机构设备配置明显增加,科室设置基本齐全,人员的职称和学历结构得到优化,机构服务内容得到拓展,服务量大幅提高,管理信息系统也有一定发展。结论UHPP项目的社区卫生服务机构发展迅速,但目前仍需加强城市社区卫生服务机构专业人才培养及完善管理信息系统。