Epidemiology of ageing in Northeastern Brazil: results of a household survey

INTRODUCTION: The population of Brazil is ageing very rapidly, and the care of the elderly is an emerging priority. Up to this date, there is no comprehensive study addressing the profile of the elderly in Northeastern Brazil. The objective is to compile the multidimensional profile of the elderly residents in a metropolitan area of Northeastern Brazil. METHODS: Six hundred sixty-seven elderly (60 years and over), residents in the city of Fortaleza, Ceará, Brazil, constituting a multistage random sample stratified by socioeconomic status. The data was gathered by household survey using a multidimensional functional assessment questionnaire. RESULTS: The majority of the elderly were living in multigenerational households (75,3%). More than half (51,9%) lived without the spouse; 92,4% mentioned at least one disease; 26,4% were considered psychiatric cases; 47,7% showed loss of autonomy; 6,6% were hospitalized, and 61,4% used health services within the twelve and six months preceding the interview, respectively. The prevalence of multigenerational households, loss of autonomy and psychiatric morbidity were higher in the poorest areas. CONCLUSIONS: The elderly population in the city of Fortaleza lives mainly in multigenerational households, with physical and mental morbidity rates particularly high in poor areas, they represent special concern in terms of burden for the social and health services in the next decades     

Low utilization of community health workers: results from a household interview survey in Burkina Faso

A representative household survey was carried out in order to study the utilization of community health workers (CHW) in relation to other sources of health care. We found three main results: (1) For mild diseases, villagers consulted their CHW only in 8.8% of mild diseases, in 69% the family remained the main provider of primary care. (2) In the case of serious diseases, which the CHW was supposed to identify and refer, the villagers bypassed the CHW in 96.5%. The professional health worker were consulted directly in the majority of serious disease. (3) Sick infants were not taken to the CHW for treatment. (4) No pattern of referral between professional and CHWs could be traced. Severity of disease and perceived effectiveness of the treatment were the most important determinants of health seeking behavior. Availability, distance, and cost of travel and drugs were important service related determinants. Individual and household characteristics such as income, ethnicity, and household size were only weakly associated with choice of curative care. Reasons for the low utilization of CHWs are outlined and policy implications discussed.     

Health care decisions at the household level: results of a rural health survey in Kenya

The observed visits to health care providers are an outcome of patients' health care decision-making process. Unlike the visits, this process is not observable. The paper first outlines this process, and then presents patterns of patients' visits to health care providers in a particular rural area in Kenya. The visit patterns are shown to vary greatly according to type of illness and to the stage of the illness. The paper has two main results. The first result is that in the study area, the majority of the patients sought medical treatment outside the 'free' government health care system. The other finding is that for a given illness episode, there is a very high likelihood of a patient consulting more than one provider for advice or treatment.     

Estimating the proportion of homes with functioning smoke alarms: a comparison of telephone survey and household survey results.

OBJECTIVES: This study determined the proportion of homes with functioning smoke alarms in a low-income area experiencing a high rate of residential fire-related injuries. METHODS: An on-site survey of households was conducted to confirm the results of a telephone survey. RESULTS: In the telephone survey, 71% of households reported having functioning smoke alarms. In the household survey, 66% of households reported having functioning alarms; however, when the alarms were tested, the percentage dropped to 49%. CONCLUSIONS: Telephone surveys may overestimate the presence of functioning smoke alarms in some populations. Thus, the use of telephone surveys to establish baseline measures could significantly affect the evaluation of smoke-alarm giveaway programs.     

Managing a household survey: a practical example from the KENQOL survey. Kenya Quality of Life

It is vital that surveys are well managed for results to be reliable and meaningful. Poorly managed surveys can result in falsified, lost or incomplete data. Good management requires time to plan and think about all those involved in the process of the survey: the respondents, interviewers, supervisors, coders and the wider community. This paper draws on our experience of running a randomized household survey in three locations in the rural area of Makueni district, Eastern Kenya. The paper outlines the various strategies used to: gain access to the local community; recruit and train interviewers; supervise; plan day to day activities; and manage data.     

Diminishing marginal disutility of hypoglycaemic events: results from a time trade-off survey in five countries

Introduction

The negative impact of hypoglycaemic events on health-related quality of life (HRQoL) may be evaluated by attaching published disutilities to these events. It is suggested that the marginal negative impact of individual hypoglycaemic events on HRQoL may decrease as the overall frequency increases.

Methods

Using disutility values from a large-scale (>8,000 respondents), time trade-off (TTO) study, nonlinear regression curves were fitted to the total disutility of different frequencies of non-severe daytime and nocturnal hypoglycaemic events. Nonparametric bootstrapping was applied to characterise the uncertainty of the marginal disutility.

Results

Power function regression curves were estimated at U _d = 0.0141x ^0.3393 and U _d = 0.0221x ^0.3277. An increase from 0 to 1 hypoglycaemic event per year produced a utility decrease of 0.0141 and 0.0221 for non-severe daytime and nocturnal events, respectively. An increase from 25 to 26 events per year produced a marginal impact of 0.0006 and 0.0008 for non-severe daytime and nocturnal events, respectively.

Discussion

These data concur with the noted phenomenon of “first being worst” as regards hypoglycaemic events. This finding may reflect a coping mechanism on the part of patients, a maximum limit for trading off remaining lifetime or the nature of the study.

Conclusion

Applying nonlinear functions to the TTO data might improve the precision of the measured impact of hypoglycaemic events.     

Social inequalities and health services use: evidences from a stratified household survey

OBJECTIVE: The study aims to identify children who are not benefited by local health programs, looking for to characterize the excluded segment of the population in order to broaden the access to and use of the main actions provided by local health programs. METHODS: A sample of 465 children aged less than 1 year was studied, living in the year of 1996 in Embu, a city of the metropolitan area of S. Paulo, Brazil. Our hypothesis was that there is a higher availability of private health care resources among families who haven't been using the local health program. The statistical analysis consisted of stratified association analysis to study the heterogeneity between and intra four strata of families defined by different socioeconomic conditions. RESULTS: Although only 85.4% of the study children were enrolled in local health services, 91.2% of them were being benefited by main health care actions. The analysis of differences intra strata revealed that our hypothesis was only corroborated in one stratum. It is in the stratum 3, which concentrates the peripheral population, where we could find children who have not been using the local health program in Embu city. CONCLUSIONS: In the same social segment it was detected some inner heterogeneity among families related to the availability of private resources for their children health care.     

Transgender health in Massachusetts: results from a household probability sample of adults

Despite higher rates of unemployment and poverty among transgender adults (n = 131; 0.5% weighted) than among nontransgender adults (n = 28,045) in our population-based Massachusetts household sample, few health differences were observed between transgender and nontransgender adults. Transgender adults who are stably housed and participated in a telephone health survey may represent the healthiest segment of the transgender population. Our findings demonstrate a need for diverse sampling approaches to monitor transgender health, including adding transgender measures to population-based surveys, and further highlight economic inequities that warrant intervention.     

Providing healthcare under ISIS: A qualitative analysis of healthcare worker experiences in Mosul,Iraq between June 2014 and June 2017

ABSTRACT

During ISIS occupation of the Northern Iraqi city of Mosul between June 2014 to June 2017, healthcare workers remaining in Mosul continued to provide medical services. Little is currently known about Iraqi healthcare workers’ personal and professional lives in the ISIS healthcare system, and how these individuals adapted. This study sought to explore their experiences during occupation through thematic analysis of qualitative data from twenty interviews conducted immediately after ISIS withdraw from Mosul in August 2017. Participants were sampled from healthcare facilities still in operation after liberation and included healthcare workers of varying disciplines, age and gender. Participants described major changes to their personal and professional lives under ISIS and an extremely limited perceived ability to negotiate the challenges of providing healthcare in the ISIS system. They described terrifying working environments, the strict separation between the sexes, restricted movement, and continuous monitoring by the Al-Hesba morality police. Infractions of ISIS law and subsequent punishment, deaths and kidnappings, changes in personal relationships, poverty and the disrupted schooling of children were also discussed. The importance of protection by supervisors, access to additional money and transportation were highlighted. Understanding these hardships may help support the recovery of health workers experiencing similar situations.

Abbreviations: HCW: Healthcare Worker; PHCCs: Primary Health Care Clinics; ISIS: Islamic State of Iraq and Syria     

Aspirin use among adults aged 40 and older in the United States: results of a national survey

BACKGROUND: Aspirin is effective for the primary and secondary prevention of cardiovascular events, but its use has been suboptimal. METHODS: Investigators performed a nationally representative Internet-based survey of U.S. consumers aged 40 and older using online databases maintained by Harris Interactive((R)) to measure use of aspirin for cardiovascular disease (CVD) prevention and factors associated with its use. Respondents reported whether they used aspirin therapy regularly for cardiovascular prevention; and provided information about their cardiovascular risk factors, discussions with their healthcare provider about aspirin therapy, and their perceptions about risks and benefits of aspirin. Objective risk of cardiovascular events was estimated using counts of self-reported risk factors. Survey results were weighted to be representative of the general U.S. population. Researchers performed bivariate and multivariate analyses to understand factors associated with aspirin use. RESULTS: A total of 1299 adults aged 40 or older completed the survey. Mean age was 55.9, 53% were women, 79% self-identified as white, 10% African American, and 9% Latino. Current regular aspirin use for CVD prevention was reported by 41% of respondents. The factor most strongly associated with aspirin use was reporting a previous conversation with a healthcare provider about aspirin (88% aspirin use among respondents reporting such discussion versus 17% who did not report discussion; odds ratio 36.6, 95% confidence interval 25.9-51.7). CONCLUSIONS: Aspirin use is low, even among patients at increased risk. Better provider-patient communication about aspirin prevention is associated with greater use, and should be a target for future interventions.     

Nutrition survey in the Republic of the Congo: results from a national survey conducted in 1987

The objective was to evaluate the nutritional status of preschool children in the rural areas in order to establish a baseline for the measurement of the impact of a Government Nutrition Education Project (NUTED) in forthcoming years. The household cross-sectional survey was carried out on a representative sample of the rural population. The sample was stratified in order to portray the nutritional status of the children in the northern regions (more thinly populated) and in the southern regions: one stratum for small towns (between 2000 and 30,000 inhabitants) and 4 strata for rural localities. The sampling method used was by clusters of 30 children, distributed randomly in 20 zones per stratum. The nutritional indices of 2429 children were calculated and analysed according to WHO recommendations. The prevalence of the different types of malnutrition was 27.5% (95% confidence interval (CI), 24.2-30.8) for stunting (height-for-age retardation) and 5.5% (CI = 4.2-6.8) for wasting (weight-for-height retardation). Both types coexisted among 1.9% of the children; 23% of children were underweight for their age (CI = 21.6-26.2), and 15.8% (CI = 14.7-16.9) aged greater than 12 months had a mid-arm circumference below 135 mm. No sex difference was observed in the results. Stunting seems to appear in the second trimester of life (3-5 months), and wasting appeared between 9 and 23 months (highest rate between 12 and 17 months: 14.0% (CI = 9.3-18.8], which presents a real public health problem. The stratification did not show any significant differences in nutritional status among the children living in rural zones and those living in the small towns. However, the prevalence of malnutrition in the rural zones was 2 or 3 times higher than that observed in 1986 in Brazzaville. The division of the country into five main ecological zones allows some useful comparisons, e.g., the prevalence of stunting ranges from 15.5% (CI = 12.8-18.2) in the northern inundated forest zone to 38.8% (CI = 32.9-44.7) in the southern forests of Mayombe and Chaillu. The diet also varied, the frequency of animal protein consumption on the preceding day ranging from 76.3% to 59.1% in the different zones. The Republic of the Congo differs from other African countries in having relatively lower rates of stunting but an astonishingly high prevalence of wasting.(ABSTRACT TRUNCATED AT 400 WORDS)     

Public attitudes towards patient payments in Bulgarian public health care sector: results of a household survey.

This paper analyses the attitudes towards patient payments in the Bulgarian public health care sector. The analysis is based on results of a household survey conducted in the region of Varna (the third largest city in Bulgaria) between May and June 2000. The data are collected through interviews based on a standardised questionnaire and are analysed by non-parametric statistical procedures. The results show that the majority of the respondents accept to pay for public health care services if these services are provided with good quality and quick access. On average, charges for primary and dental care receive higher approval than charges for hospital services. A large percentage of the sample disagrees with charges related to actual service cost or service quality and nearly all respondents consider a ceiling on payments appropriate. According to the majority of the interviewed, the charges should be retained at the place of service provision. The sample shows strong support for an extensive system of exemptions from payments.     

Bullying in middle school: results from a 2008 survey

A survey conducted in 2008 among 346 American middle school students in several cities determined that 82.7% of respondents found bullying to be a problem of some degree, with 46.0% rating it a "medium", "bad", or "very bad" problem. It was found that 89% had witnessed an act of bullying and 49.1% said they had been the victim of a bully. Boys were significantly more likely than girls to say that a victim deserved to be bullied (11.1% vs. 1.3%, p = 0.01), whereas girls were significantly more likely than boys to fail to intervene because they did not know what to do (30.3% for girls vs. 11.1%, p < 0.01). There was no significant difference in this study between boys and girls in terms of being a bully: 43.6% admitted they had bullied another (46.2% boys, 41.1% girls, p = 0.34); however, girls were significantly more likely than boys to bully by excluding others and gossiping about them than by hitting, teasing, or threatening. Cyberbullying, surveyed as a distinct entity, had affected 31.1% of respondents directly, with similar results from 2006 to 2007 surveys. Of those who found conventional bullying a "bad" or "very bad" problem at their schools, numbers fell from 17.3% in 2006-2007 vs. 11.3% in 2008.     

Race/ethnicity differences in the validity of self-reported drug use: Results from a household survey

Data were analyzed from a multistage probability household survey of over 600 adults, ages 18–40 from the city of Chicago conducted during 2001–2002. The survey employed audio computer-assisted self-interviews to obtain information about drug use. To imvestigate racelethnicity differences in reporting validity, drug test results were compared with self-reports of past month drug use for cocaine, marijuana, and a combined indicator of both substances. The main indicators of validity were self-report sensitivity and concordance. Possible theoretical models accounting for potential cultural differences in reporting validity were discussed. Survey variables reflecting these potential explanations were examined as potential mediators of racelethnicity differences in validity and as direct correlates of validity. Socioeconomic status was identified as one potential mediator. With this exception, racelethnicity differences suggesting lower levels of marijuana and cocaine concordance for African Americans as compared with Whites were sustained after controlling for potential mediators. Methodological implications for epidemiological and health disparities research are discussed.     

A moment in time: selected results from the 1996-1997 New Zealand health survey.

This article presents key results from the 1996-1997 New Zealand Health Survey, the second of two nationally representative surveys on the health status and health service utilization of New Zealanders. This survey involved a face-to-face interview with 7,862 adults and 1,019 children carried out during the period of a year. The survey had an adult response rate of 73.8%. Using the results of this survey, this article highlights some of the major public health issues facing New Zealanders. These issues include smoking, physical inactivity, alcohol use, asthma, and diabetes. The results presented here show that significant disparities exist between particular demographic and socioeconomic groups in New Zealand in relation to both health risk factors and specific chronic diseases. The policy implications of the results are discussed in relation to existing public health strategies and future initiatives.