Relation between socioeconomic status,employment, and health during economic change, 1973-93.

OBJECTIVE: To investigate the association between the national unemployment rate and class differences in the relation between health and employment during the period 1973-93. DESIGN: Data from general household surveys, 1973-93. Comparison of rates of employment, unemployment, and economic inactivity among those with and without limiting longstanding illness in different socioeconomic groups and how these varied over 20 years. SUBJECTS: All men aged 20-59 years in each survey between 1973 and 1993. MAIN OUTCOME MEASURES: Change over time in class specific rates of employment, unemployment, and economic inactivity in those with and without limiting longstanding illness. RESULTS: Men in socioeconomic groups 1 and 2 with no longstanding illness experienced little decrease in their chances of being in paid employment as the general unemployment rate rose. Those most affected were men in manual groups with limiting longstanding illness. The likelihood of paid employment was affected far less by such illness in non-manual than in manual groups. In group 1 about 85% of men with such illness were in paid employment in 1979 and 75% by 1993; in group 4 the equivalent proportions were 70% and 40%. In men in manual groups with limiting longstanding illness there was no sign of employment rates rising again as the economy recovered. CONCLUSION: Socioeconomic status makes a large difference to the impact of illness on the ability to remain in paid employment, and this impact increases as unemployment rises. Men with chronic illness in manual occupations were not drawn back into the labour force during the economic recovery of the late 1980s.     

Analysis of the sociodemography of gonorrhoea in Leeds, 1989-93.

OBJECTIVE: To investigate the epidemiology of gonorrhoea in an urban area in the United Kingdom. DESIGN: Analysis of all cases of gonorrhoea with regard to age, sex, ethnic group, and socioeconomic group with 1991 census data as a denominator. SETTING: Leeds, a comparatively large urban area (population around 700,000) in the United Kingdom. SUBJECTS: All residents of Leeds with culture proved cases of gonorrhoea during 1989-95. MAIN OUTCOME MEASURE: Relative risk of gonorrhoea. RESULTS: Sex, age, race, and socioeconomic group and area of residence were all independently predictive of risk of infection. Young black men aged 20-29 were at highest risk, with incidences of 3-4% per year. Black subjects were 10 times more likely than white subjects to acquire infection, and subjects from the most deprived socioeconomic areas were more than four times more likely than those from the most affluent areas to acquire infection. CONCLUSIONS: Different ethnic and socioeconomic groups vary in their risk of infection with gonorrhoea within an urban area. Targeted interventions and screening to reduce the incidence of sexually transmitted disease are now priorities.     

The people's role in U.S. national health security: past, present, and future

Over the past decade, assumptions have been made and unmade about what officials can expect of average people confronting a bioterrorist attack or other major health incident. The reframing of the public in national discourse and doctrine from a panic-stricken mob to a band of hearty survivors is a positive development and more realistic in terms of the empirical record. So, too, is the realization that citizen contributions to national health security encompass not only individual preparedness and volunteerism but also mutual aid and collective deliberation of the tough choices posed by health disasters. In projecting what needs to occur over the next 10 years in biosecurity, 2 priority challenges emerge: retaining the lesson that a public prone to panic, social disorder, and civil unrest is a myth, and building an infrastructure to bolster the public's full contributions to health emergency management.     

The U.K. Acid Waters Monitoring Network: an assessment of chemistry data, 1988–93

1. The current extent and distribution of acidified surface waters in the U.K. is assessed using data collected between 1988 and 1993 as part of the U.K. Acid Waters Monitoring Network (AWMN). The data have been collected against a background of constant S deposition across the U.K. throughout the monitoring period. 2. Surface waters with mean pH < 5.0 occur in south-west Scotland, south-east Northern Ireland, the Lake District and south-east England. In addition, sites with mean pH < 5.5 are found in central and north-east Scotland, the Pennines and north Wales. These areas receive, and have historically received, high levels of S deposition and xSO₄ is identified as the main contribution to non-marine acid anion concentrations. 3. Mean total oxidized nitrogen (TON) concentrations are > 10 μeq l^–1 at ten of the twenty-two sites which are found in areas broadly corresponding to areas of high N deposition. The mean contribution of TON to total non-marine acid anion concentration is > 10% at sixteen sites and > 20% at six sites. Most sites, except for those with TON < 10 μeq l^–1 and mainly located in north-west Scotland and Northern Ireland, demonstrate strong seasonality in TON concentrations and during autumn and winter instantaneous contributions of TON to total non-marine acid anions is up to 60%. This confirms the importance of N with respect to surface water acidification and strengthens the case for implementation of controls on future N emissions. 4. The data period is currently too short for rigorous trend analysis given the monthly/quarterly sampling frequency in streams/lakes, respectively. Nevertheless, increased SO₄ and xSO₄ can be observed in the time series at sites in south-west Scotland and north Wales despite constant deposition to these areas. Similar trends are evident in longer-term more frequent data at two sites and may reflect hydrometeorological influences, especially the duration and intensity of hot and dry weather in summer which promotes mineralization of organic S.     

Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa

Coercion may play an important role in compelling young women to engage in sexual intercourse at an early age. With a decline in age at first intercourse and increased reporting of coercive first sex, concerns of adverse reproductive health outcomes such as unintended pregnancy and sexually transmitted infections (STIs), including HIV, have become important issues, particularly in the context of a high HIV prevalence. This paper uses data collected in 2001 from the second round of a longitudinal study of 1130 sexually experienced young women in KwaZulu-Natal to investigate the relationship between coerced first intercourse and selected reproductive health outcomes and behaviours. Nearly 46% of all sexually experienced young women had reported that their first sexual encounter had been coerced. Young women who reported being coerced at first sex were significantly more likely to be Black and living in an urban area. Those who had been coerced at first sex were also more likely to report having had an STI and having experienced unintended pregnancy, than those who had not been coerced at first sex. Coercion at first sex is an important social and public health problem that has a serious impact on the reproductive health and behaviours of young women. Interventions should directly address the issue of sexual coercion by ensuring young women are aware of their reproductive rights.     

Some experience in an area health authority child health clinic.

Three years'' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work.     

Epidemiology of suicide pacts in England and Wales, 1988-92.

OBJECTIVE: To describe the epidemiology of suicide pacts in England and Wales DESIGN: Analysis of the death certificates and coroners'' records of all people who died in pacts between 1 January 1988 and 31 December 1992. SUBJECTS: 124 people who committed suicide in 62 pacts. RESULTS: Suicide in a pact accounted for 0.6% of all suicides (124/19721), a rate of 0.6 per million people aged 15 and over. Forty eight pacts were between married couples and five were between family members. The mean age was 56 years. 99 of the 124 subjects were of occupational social classes I-III. Poisoning by car exhaust fumes and drugs accounted for 116 deaths, with both members of each pair using the same method. CONCLUSIONS: Suicide pacts are rare and less common than they were 35 years ago, although the epidemiological profile is similar. People who commit suicide in a pact are more likely than those who commit suicide alone to be female, older, married, and of a high social class.     

Rich-poor gap in utilization of reproductive and child health services in India, 1992-2005

This paper examines the trends in utilization of five indicators of reproductive and child health services, namely, childhood immunization, medical assistance at delivery, antenatal care, contraceptive use and unmet need for contraception, by wealth index of the household in India and two disparate states, Uttar Pradesh and Maharashtra. The data from three rounds of the National Family and Health Survey conducted during 1992-2005 are analysed. The wealth index is computed using principal component derived weights from a set of consumer durables, land size, housing quality and water and sanitation facilities of the household, and classified into quintiles for all three rounds. Bivariate analyses, rich-poor ratio and concentration index are used to understand the trends in utilization of, and inequality in, reproductive and child health services. The results indicate huge disparities in utilization of these services, largely to the disadvantage of the poor. Utilization of basic childhood immunization among the poorest and the poor stagnated in India, as well as in both states, during 1998-2005 compared with 1992-1998. The use of maternal care services such as medical assistance at delivery and antenatal care remained at a low level among the poor over this period. However, contraceptive use increased relatively faster among the poor, even with higher unmet need. Of all these services, the inequality in medical assistance at delivery is consistently large, while that of contraceptive use is small. The state-level differences in service coverage by wealth quintiles over time are large.     

Distribution of ovine hydatidosis in Sardinia, 1987-1988

The prevalence of Echinococcus granulosus in sheep was examined in Sardinia between June and September 1987-1988. Of the examined sheep 243 were being pastured in fenced fields while 1084 were being pastured in open fields. An infection rate of 1.6% was recorded in the first group of sheep, and 86.7% in the second. The prevalence rate differed in various parts of the region, ranging from 79.4% (Oristano province) to 95% (Nuoro province). Of the parasitized sheep 7.9% harboured only fertile cysts, and 74.1% only sterile cysts. The latest figure is surprising compared to data previously reported in the literature. Most of the sheep examined were infected in both organs (67.4%) but only 27.4% of these showed a massive infection with over 10 hydatid cysts. The variation in prevalence rate and epidemiological implications are discussed.     

Adolescent smokers seen in general practice: health,lifestyle, physical measurements,and response to antismoking advice.

OBJECTIVE--To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling. DESIGN--Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check. SETTING--Three general practices in the MRC general practice research framework. MAIN OUTCOME MEASURES--Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems. RESULTS--73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p <0.001) [corrected]. Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking. CONCLUSION--General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.