Changes in the physical development of Kiev schoolchildren over a ten-year period (1996-2008)

Physical development and morphofunctional state were assessed in 2452 urban schoolchildren, by using the Ukrainian standards (intergroup regression scales). During their schooling, the Kiev schoolchildren of both sexes were shown to have significant qualitative and quantitative physical and morphofunctional worsening that was more obvious in boys. Not more than 57-59% of the Kiev children aged 6 to 17 years had normal physical development and harmonic morphofunctional state. Every six Kiev boys and every five girls had overweight and reduced chest circumference. In the period 1996-2008, there was significant weight gain without respective changes in chest circumference and height, which indicated an imbalance in growth processes and physical development in the present-day Kiev schoolchildren. Evaluation standards for schoolchildren's physical development were developed and put into practice of the state sanitary-and-epidemiological service of Ukraine.     

Epidemiology of parainfluenza virus type 3 in England and Wales over a ten-year period

We have analysed data on respiratory syncytial (RS) and parainfluenza type 3 (PF3) viruses reported to the Communicable Disease Surveillance Centre, London, over the period 1978-87. These confirm the annual winter epidemic of RS virus and show that, in England and Wales, PF3 is a summer infection with regular yearly epidemics.     

Substance-attributable morbidity and mortality changes to Canada's epidemiological profile: measurable differences over a ten-year period

BACKGROUND: Substance use is responsible for a large burden of disease in Canada, however updated data are needed for health care planning and policy development. This study replicates and makes improvements on 1992 estimates of substance-attributable morbidity and mortality for the year 2002. There are two objectives, the main one being to compare the substance-attributable morbidity and mortality in 1992 with 2002 using the same methods of calculation, and the second, to compare the two different methods of estimating the substance-attributable mortality and morbidity in 2002. METHOD: Estimates of substance-attributable burden were made by combining relative risk data with exposure prevalence data and disease-related mortality and morbidity information from national databases. First, identical relative risk estimates for 1992 were used with the 2002 data in order to draw direct comparisons. In a second analysis, updated relative risk and attributable disease information (post-1992) was used to better estimate the mortality and morbidity for Canada in 2002. RESULTS: Overall, from 1992 to 2002, there were relative increases in substance-attributable mortality estimates for alcohol and illegal drugs, where the latter relatively increased more; and a relative decrease in tobacco-attributable mortality. In terms of absolute numbers in combined risk factors, deaths and hospital days for those under 70 years of age decreased mainly due to tobacco. Comparisons of the two methods showed that the updated method resulted in more conservative numbers than previous calculations. INTERPRETATION: There is an unacceptably high burden of substance-attributable disease in Canada in the early 2000s. Exposure changes and epidemiological shifts in population and diseases over the last 10 years have affected where the burden lies, but it is still vital to incorporate policy-based initiatives that have proven to be effective in reducing substance-attributable burden in practice.     

Acute toxicological cases during a ten-year period in our clinic

INTRODUCTION: There's a fact, that Hungary has held the first places in suicidal statstics. METHODS: The authors studied toxicological cases between 1989 and 1998 at the 1st Department of Medicine of the Medical and Health Science Centre, at the University of Debrecen, paying special attention to suicidal poisoning cases. RESULTS: 2% of the patient turnover accounted for acute poisoning cases, the number of which increased during the 10 years in question. 70% of the cases were of suicidal intentions, 20% were unintentional, these poisonings were not committed on purpose, while the proportion of iatrogenic intoxication cases was 10%. Amongst the failed suicide cases there was a higher proportion of women, whereas a higher percentage of men accounted for "successful" suicide cases. When examining auto-intoxication cases it turned out that the medicine most frequently used was meprobamate, besides benzodiazepines. Mortality rate was highest in the glutethimide intoxication cases. Most poisonings with suicidal intentions took place in the 2nd quarter of the year. Most completed suicides were committed on Wednesdays and Thursdays. 81% of the iatrogenic intoxication cases happened to be with digitalis and coumarin overdose. Nearly 50% of the cases turned out to be combined intoxications. 40% of the men took alcoholic drinks during the auto-intoxications. In the case of 135 patients extracorporeal detoxification therapy was applied, which consisted mostly of hemoperfusion. Three quarters of the patients needed psychiatric care and every fourth patient was admitted to the Department of Psychiatry. 6.9% of the poisonings were fatal. CONCLUSIONS: The growing number of toxicological cases--amongst these suicidal poisonings--compels us to pay more attention to the setting up of interdisciplinary based prevention as well as running effective toxicological centres. All physicians have a responsibility to recommend psychiatric care for people suffering from mental problems or depression and for the unsuccessful or potential suicide seeking help for the first time. Family doctors in primary medical care and who meet patients first have an important role in this job.     

北京、广州城乡人群工作时体力活动现状及其10年间变化情况

目的描述中国南北城乡人群工作时间体力活动现状及过去10年的变化趋势。方法整群随机抽取北京城市、北京农村、广州城市和广州农村4组人群3304人,采用标准化问卷、收集工作时间体力活动及10年间变化资料,计算每个人日常工作时间单位体重的能量消耗(kJ/kg)。结果中国南北城乡人群工作时间体力活动处于较低水平,极轻和轻体力工作者占总人数的59.4%,工作时间体力活动强度呈现男性高于女性、南方高于北方、农村高于城市的特点。与10年前相比,工作时间体力活动强度降低、不变和增加者分别为48.8%、38.0%和13.2%,降低者比例呈现农村高于城市、男性高于女性、随年龄增加而增加、随文化水平降低而增加的特征。结论中国南北城乡人群工作时间体力活动较低及过去10年降低的趋势提示中国需要增加公共健康投资,包括制定策略和公众教育。     

Graduate education in family practice: a ten-year review.

Assessment of the progress of graduate education in family practice after ten years shows that the original goals established for residency training in this specialty are being effectively met. There are now more than 360 approved family practice residencies in the United States with over 6,000 residents in training. Student interest in these programs has remained at a high level, and attrition has been low. Graduates of these programs have favored partnership and group family practice, and are well distributed in rural, suburban, and metropolitan areas. Heavy emphasis has been placed upon quality control mechanisms for both internal and external review of family practice residency programs. This paper outlines some concerns regarding the present status of family practice residencies, and suggests some directions for future development of these programs.     

Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg

OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.     

Changes in racial categorization over time and health status: an examination of multiracial young adults in the USA

Objective. Multiracial (two or more races) American health related to racial stability over the life course is a pressing issue in a burgeoning multi-ethnic and multicultural global society. Most studies on multiracial health are cross-sectional and thus focus on racial categorization at a single time point, so it is difficult to establish how health indicators change for multiracials over time. Accordingly the central aim of this paper was to explore if consistency in racial categories over time is related to self-rated health for multiracial young adults in the USA.Methods. Data were drawn from the National Longitudinal Study of Adolescent Health (Add Health) survey (N = 7957). Weighted multivariate logistic regression was used to exam health status in early adulthood between individuals who switched racial categories between Waves 1 and 3 compared to those who remained in the same racial categories.Results. There were significant differences in report of self-rated health when comparing consistent monoracial adults with multiracial adults who switch racial categories over time. Diversifying (switching from one category to many categories) multiracial respondents are less likely to report fair/poor self-rated health compared to single-race minority young adults in the fully adjusted model (OR = 0.20; 95% CI [0.06–0.60]).Conclusion. These results demonstrate the importance of critically examining changes in racial categories as related to health status over time. Furthermore, these results demonstrate how the switch in racial categories during adolescence can explain some variations in health status during young adulthood.     

Effects of body fat and its development over a ten-year period on glucose tolerance in euglycaemic men: the Zutphen Study

The relationship between body fat and different aspects of glucose tolerance was examined within the Zutphen Study. In 1970 an oral glucose tolerance test (OGTT) was carried out in 404 non-diabetic men aged 50-70. None of the subjects could be classified as having impaired glucose tolerance. Body mass index (BMI), subscapular and triceps skinfold were positively related with fasting and 60 min serum glucose. Weak positive associations were found between 30 min glucose, BMI, and subscapular skinfold. For 120 min glucose, only the relationship with subscapular skinfold was significant. After adjustment for age and the other body fat indicators, the positive associations between body fat and fasting, 60 min and 120 min glucose were confirmed for subscapular skinfold only. Correlations between these glucose measurements and measurements of subscapular skinfold in the years between 1960 and 1970 were also significant and increased with time. Independent from subscapular skinfold in 1970 and age, changes in skinfold during the period 1960-70 were in general not significantly associated with glucose levels, except for 30 min glucose. The findings could to a large extent be explained by current knowledge of glucose metabolism.     

The impact of multimorbidity on resting metabolic rate in community-dwelling women over a ten-year period: A cross-sectional and longitudinal study

Objectives

Ageing has been associated with increasing multimorbidity. This study investigated whether the number of diseases is a predictor of resting metabolic rate (RMR) and its long-term changes in community-dwelling elderly women.

Subjects and Design

Cross-sectional and longitudinal data, obtained over ten years with repeated follow-ups, from 180 women aged 60–86 years and with a BMI of 18–43 kg/m² at baseline were analyzed.

Measurements

RMR was measured using indirect calorimetry and body composition by bioelectrical impedance analysis. Diagnosed diseases were assessed by a questionnaire comprising 23 disease categories. Subjects with 0–2 diseases were classified as relatively healthy and with > 2 diseases as multimorbid.

Results

At baseline, relatively healthy (N = 75) and multimorbid (N = 105) women did not differ in RMR. During the ten-year follow-up, the median (range) number of diseases increased from 2 (0–2) to 4 (0–8) in relatively healthy and from 5 (3–11) to 7 (3–15) in multimorbid women. In the longitudinal analyses, only women who were multimorbid at baseline showed a significant increase in RMR of 31 kJ/d per additional disease (P = 0.015), adjusted for fat-free mass, fat mass, waist circumference and age.

Conclusion

Increasing multimorbidity in community-dwelling women is associated with an increase in RMR independently of body composition and age.

     

An evaluation of contraceptive knowledge and practice in an urban community in Benin City in Nigeria

Cultural and religious objections to family planning among Nigeria's Catholics and Moslems have comprised a serious obstacle to sex education efforts. This study compared contraceptive knowledge and practices among 2 random samples in Benin City: students at an urban female teachers training college and mothers of children brought to an urban health center. All of the 260 women surveyed at the health center were married; among the 175 teachers in training, 104 (59%) were married, 68 (39%) were single, and 3 (1%) were divorced. The contraceptive prevalence rate was 20% among mothers attending the child health center compared with 53% among student teachers (72% among married teachers and 38% among single teachers). Among future teachers, contraceptive awareness was higher among single women (49%) than married women (39%). The predominant forms of contraception used by teacher trainees were the pill (22%), condom (18%), rhythm (13%), the IUD (115), Depo-Provera injections (115), and abstinence (8%). The major sources of contraceptive awareness reported by these women were boyfriend (18%), sister (16%), nurse (14%), friend (13%), and television (13%). 29% of the teachers in training indicated they themselves had made the decision to use contraception, while 43% cited the influence of husband or boyfriend and 19% were motivated by medical personnel.     

General medical practice in a multicultural and multiracial environment: report from a multidisciplinary casework seminar.

The impact of culture and race on the doctor-patient relationship, and hence on management, treatment and outcome, is not yet part of medical training programmes. This is true for graduate and undergraduate levels. In order to explore the format for such training, a pilot inter professional seminar in transcultural casework was carried out in East London over two terms in 1987. The initiative for the course was taken by a small group of professionals in psychiatric, primary health care, probation and social services. Nafsiyat, an inter-cultural therapy centre based in London, was approached and asked to provide a facilitator for the seminar. Participation in the seminar and dissemination of the lessons learned formed part of the work of Community Roots Project, Department of General Practice, St Bartholomew's Hospital Medical College. The Project has worked, through development work, group work and training, to explore ways of strengthening relationships between primary health care facilities and the communities they serve. The paper outlines some of the issues discussed in the seminar.     

Changes in primary health care centres over the transition period in Slovenia

BACKGROUND: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. METHODS: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. RESULTS: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. CONCLUSIONS: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.