The pattern of mucocutaneous disorders in HIV – infected children attending care and treatment centres in Dar es Salaam, Tanzania

Background  

HIV/AIDS is associated with a wide range of mucocutaneous disorders some of which are useful in the clinical staging and prognosis of the syndrome. There is paucity of information regarding the prevalence and pattern of mucocutaneous disorders among HIV infected children attending paediatric Care and Treatment Centres (CTC) in Dar es Salaam. Objective To determine the prevalence and pattern of mucocutaneous disorders among HIV infected children attending public paediatric 'Care and Treatment Centres' in Dar es Salaam.     

Geographic aspects of poverty and health in Tanzania: does living in a poor area matter?

Previous studies have consistently found an inverse relationship between household-level poverty and health status. However, what is not well understood is whether and how the average economic status at the community level plays a role in the poverty-health relationship. The purpose of this study is to investigate the concentration of poverty at the community level in Tanzania and its association with the availability and quality of primary health care services, the utilization of services, and health outcomes among household categories defined by wealth scores. A principal component method has been applied to rank households separately by urban/rural location using reported levels of asset ownership and living conditions. The household wealth scores were also used to classify communities into three cluster-types based on the proportion of households belonging to the poorest wealth tercile. On average, all the wealth terciles living in low poverty concentration areas were found to have better health outcomes and service utilization rates than their counterparts living in high poverty concentration clusters. Consistent with the finding is that high poverty concentration areas were further away from facilities offering primary health care than low poverty concentration areas. Moreover, the facilities closest to the high poverty concentration areas had fewer doctors, medical equipment and drugs. Among the high poverty concentration clusters, the 10 communities with the best women's body mass index (BMI) measures were found to have access to facilities with a greater availability of equipment and drugs than the 10 communities with the worst BMI measures. Although this study does not directly measure quality, the characteristics that differentiate high poverty concentration clusters from low poverty concentration clusters point to quality as more important than physical access among the study population.     

Quality of life in lung cancer patients: does socioeconomic status matter?

Background  

As part of a prospective study on quality of life in newly diagnosed lung cancer patients an investigation was carried out to examine whether there were differences among patients' quality of life scores and their socioeconomic status.     

Malnutrition in hospitalized elderly patients: when does it matter?

BACKGROUND: Identifying the individual effects of acute illness and malnutrition on elderly patient outcome and the timing of nutritional support is still an important challenge for modern medicine. OBJECTIVE: The aims of this study were to assess the practical significance of serum albumin concentrations following acute illness as a measure of nutritional status in ageing patients and also to review recently published studies related to this field. DESIGN: Consecutive stroke patients had their nutritional status assessed from anthropometric, haematological and biochemical data during the hospital stay. Predicted energy needs and daily in-hospital energy intake were also studied in a subgroup of 24 acute stroke patients and 24 age and sex-matched hospitalized non-stroke patients. A multivariate analysis was used to measure the amount of variance in serum albumin concentrations explained by nutritional and non-nutritional clinical variables. RESULTS: Serum albumin concentrations deteriorated steadily during the study period and there was an increase in the amount of variance in the serum albumin explained by nutritional variables between admission and week 4 of the hospital stay. Almost all patients studied were in negative energy balance during hospitalization. Evidence is provided which links low serum albumin concentrations with clinical outcomes during the hospital stay and immediately following discharge. That nutritional supplementation started one week as opposed to immediately following acute illness, and continued during the convalescent period, can improve serum albumin concentrations during the hospital stay. CONCLUSION: Poor nutritional status following acute illness in ageing patients may be of more prognostic significance and amenable to therapy later on during the course of hospitalization.     

Attitudes, experience, and anticipation of sex among 5th graders in an urban setting: does gender matter?

To identify gender differences in correlates of anticipation and initiation of sexual activity in the baseline survey of 562 African-American 5th grade students prior to initiation of a school-based pregnancy prevention intervention curriculum. Students from 16 elementary schools were administered the baseline questionnaire during classroom periods. Using these data, binary and ordered logistic regression models were used to analyze the factors affecting virginity and anticipation of sexual activity separately by gender, and tests of interaction between each factor and gender were conducted on the combined sample. More boys than girls had already had sex (18% vs. 5%) and anticipated having sexual intercourse in the next 12?months (56% vs. 22%). Boys and girls also differed in the factors that affected these outcomes. The perception that their neighborhood was safe reduced the odds that boys anticipated sexual activity but was not associated with this outcome among girls. Pubertal knowledge increased the odds of anticipation, but only among boys. Attitudes favoring abstinence decreased anticipation of sex among both genders, but slightly more among girls than boys. Having more frequent parent-child communication about sex was associated with increased anticipation among girls but decreased anticipation among boys. Curriculum based approaches to adolescent pregnancy prevention are appropriate for 5th grade elementary students who may already be anticipating sexual activity in communities with disproportionate rates of teen pregnancy. The design of the interventions should consider the differences in motivating factors by gender.     

Diabetes mellitus and risk of all-cause mortality among patients with tuberculosis in the state of Georgia, 2009–2012

PurposeTo estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment.MethodsFrom 2009 to 2012, a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged 16 years or older were classified by DM and human immunodeficiency virus (HIV) status at the time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios were used to estimate the association between DM and death.ResultsAmong 1325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and seven (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared with those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (P < .05). In multivariable analysis, DM was not associated with death during TB treatment (hazard ratio, 1.22; 95% confidence interval, 0.70–2.12) or any death (adjusted odds ratio, 1.05; 95% confidence interval, 0.60–1.84).ConclusionsAmong TB patients in Georgia, the prevalence of comorbid DM and coinfection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.     

Quality of life following participation in cardiac rehabilitation programs of longer or shorter than 6 months: does duration matter?

Cardiac rehabilitation (CR) participation results in significant health benefits. However, there is wide variation in program duration, and little is known about the optimal duration of CR for patient outcomes. The objective of this study was to compare quality of life (QoL) of patients who participated in CR programs of??0.0001), and PTGI (P?=?0.007) were significantly greater regardless of CR duration when compared to those who did not attend CR. There were no significant differences in outcomes when comparing patients attending CR programs of?相似文献   

The optimal duration of anticoagulation in patients with venous thromboembolism: how long is long enough?

The risk of recurrent venous thromboembolism (VTE) approaches 40% of all patients after 10 years of follow-up. This risk is higher in patients with permanent risk factors of thrombosis such as active cancer, prolonged immobilization from medical diseases, and antiphospholipid syndrome; in carriers of several thrombophilic abnormalities, including deficiencies of natural anticoagulants; and in patients with unprovoked presentation. Patients with permanent risk factors of thrombosis should receive indefinite anticoagulation, consisting of subtherapeutic doses of low-molecular-weight heparin in cancer patients, and oral anticoagulants in all other conditions. Patients whose VTE is triggered by major surgery or trauma should be offered three months of anticoagulation. Patients with unprovoked VTE, including carriers of thrombophilia, and those whose thrombotic event is associated with minor risk factors (such as hormonal treatment, minor injuries, long travel) should receive at least three months of anticoagulation. The decision as to go on or discontinue anticoagulation after this period should be individually tailored and balanced against the haemorrhagic risk. Post-baseline variables, such as the D-dimer determination and the ultrasound assessment of residual thrombosis can help identify those patients in whom anticoagulation can be safely discontinued. As a few emerging anti-Xa and anti-IIa compounds seem to induce fewer haemorrhagic complications than conventional anticoagulation, while preserving at least the same effectiveness, they have the potential to open new scenarios for decisions regarding the duration of anticoagulation in patients with VTE.     

Measuring health inequality among children in developing countries: does the choice of the indicator of economic status matter?

Background  

Currently, poor-rich inequalities in health in developing countries receive a lot of attention from both researchers and policy makers. Since measuring economic status in developing countries is often problematic, different indicators of wealth are used in different studies. Until now, there is a lack of evidence on the extent to which the use of different measures of economic status affects the observed magnitude of health inequalities.     

Are official reports sufficient? Official registration rates of patients with tuberculosis in Sivas, Middle Anatolia

PURPOSE: The main goal of this retrospective study was to re-evaluate all available records of clinical and laboratory data of patients with tuberculosis (TB) in Sivas province, Middle Anatolia, Turkey. METHODS: TB registration data held at health institutions in Sivas province were compared and matched with data obtained from the local official TB registries from January 2000 to December 2001. RESULTS: Of the 536 TB cases found in 2000 and 2001, 255 (47.6%) were officially registered. Of the 127 cases with smear-positive pulmonary TB (PTB), only nine cases labelled as smear-positive were registered in local dispensaries. The incidence of unregistered cases with smear-positive PTB found by this study was approximately 40-fold and eightfold greater than the incidence of registered cases for 2000 and 2001, respectively. CONCLUSION: There were many more unofficially recorded TB patients compared with officially recorded cases in Sivas province between 2000 and 2001. The results of this study are disappointing and alarming for Turkey's national TB control programme, at least for its regional applications.     

Sources of health information in a multiethnic, underserved, urban community: does ethnicity matter?

The Latino population is the fastest growing minority in the country, and is expected to reach about 30% of the total U.S. population by 2050. Historically, primary care practitioners are not the preferred source of health information for Latinos living in the United States. Latinos are known to rely more on media, family, and friends to get answers to health-related questions. Choosing the appropriate information source is an important component of health information-seeking behavior; it also represents a major challenge for health communicators trying to deliver information to their target audience. This study explores how ethnicity influences health information source selection among Latinos and White non-Latinos living together in an underserved, multiethnic urban community with poor health status and underlying socioeconomic characteristics. The results suggest that this community manifests a high degree of homogeneity in their usage of health information sources. Nevertheless, there are significant differences between ethnic groups and age groups on perceived usefulness of the health information retrieved from common sources. Our results suggest that health information sources that are interactive, native to the community (e.g., the local pharmacist), and promote active engagement are the most useful in delivering health messages that will be listened to by those living in this underserved, multiethnic urban community.     

Variation in preventive service use among the insured and uninsured: does length of time without coverage matter?

Lacking health insurance has consequences for the ways in which individuals seek care. In this research, the authors use data from the first panel (1996) of the Medical Expenditure Panel Survey to assess the relationship between preventive services and the length of time with insurance during a 12-month period. Regression analyses show that individuals with continuous coverage during the entire period have dramatically higher rates of preventive service use than individuals who lack coverage for all 12 months. For most services, the authors also find modest differences in preventive service use between the continually insured and those individuals with coverage for 1 to 6 months. Rates of preventive service use for individuals with 7 to 11 months of coverage are statistically indistinguishable from the continually insured. The authors' findings highlight the importance of considering the length of time without coverage when evaluating preventive service use of the uninsured population.     

Epidemic of suicide by hanging in Lithuania: does socio-demographic status matter?

OBJECTIVE: To analyse suicide by hanging, compared with other methods, by demographic and selected social factors in Lithuania, and to evaluate changes during 1993-1997, and 1998-2002. METHODS: Data on committed suicides were compiled from the Lithuanian Department of Statistics. Suicides were identified by the International Classification of Diseases (ICD): codes in ICD-9 E950-E959 and codes in ICD-10 X60-X84. These were categorized into seven groups by method of suicide. Particular attention was paid to suicide and self-inflicted injury by hanging, strangulation and suffocation (ICD-9: E953; ICD-10: X70). These data were analysed by gender, age, place of residence, education, and marital status. RESULTS: A total of 8324 suicides (6864 men and 1460 women) were committed during 1993-1997, and 7823 suicides (6455 men and 1368 women) during 1998-2002. Of all registered suicides in Lithuania during 1993-2002, hanging was the most common method. Over the period under investigation, hanging, in proportion to all other methods used to commit suicide, increased statistically significantly from 89.4% among men and 77.3% among women between 1993 and 1997 to 91.7% among men and 82.6% among women between 1998 and 2002. The most noticeable rise occurred among girls aged 10-19 years. The next most common methods among men were firearms and poisoning; among women, poisoning and jumping from high places were common methods. Hanging predominated in men, older people, rural residents and people with low levels of education. A logistic regression analysis showed that gender (odds ratio [OR]=2.4; 95% confidence interval [CI] 2.2-2.7), place of residence (OR=2.0; 95% CI 1.8-2.2) and education (OR=1.2; 95% CI 1.1-1.3), independently of other factors, had the strongest influence on the choice of hanging as the method of suicide between 1993 and 2002. Age had only a minor effect, and marital status had no significant effect on choosing hanging to commit suicide. CONCLUSIONS: Hanging is the most common method of suicide in Lithuania. The popularity of this highly lethal method may be one of the underlying causes for the high rate of committed suicides. Universal approaches to suicide prevention deserve serious consideration, especially challenging the social acceptability of hanging among men, older people, rural residents, and low educated groups of the population in Lithuania.     

Identification of racial disparities in breast cancer mortality: does scale matter?

Background  

This paper investigates the impact of geographic scale (census tract, zip code, and county) on the detection of disparities in breast cancer mortality among three ethnic groups in Texas (period 1995-2005). Racial disparities were quantified using both relative (RR) and absolute (RD) statistics that account for the population size and correct for unreliable rates typically observed for minority groups and smaller geographic units. Results were then correlated with socio-economic status measured by the percentage of habitants living below the poverty level.