Addressing the epidemiologic transition in the former Soviet Union: Strategies for health system and public health reform in Russia. T.H. Tulchinsky and E.A. Varavikova. American Journal of Public Health 86 (March 1996): 313-20.
The health system in Russia is in crisis but there is potential for change by the year 2000.
A 3-year study of statistical information and historic and recent developments on Russian health status revealed that from 1960 to 1992 total mortality increased by 65 percent. The overall life expectancy in Russia was 69 years. Trauma (accidents, homicide, suicide, and poisoning) was the leading cause of years of potential life lost by 1993, with cardiovascular disease second and neoplastic disease third. Infant mortality remained static during 1970-92, but maternal mortality rates increased. Birth rates dropped to less than 9 per 1,000 population, and abortion was the leading choice for birth control and a major contributor to the high maternal mortality rate. Inadequate food supply and poor nutrition were chronic problems. Alcoholism was epidemic, and deaths from alcohol-related diseases, accidents, and injuries were common. Infant immunization programs were deficient, and there were extraordinarily high levels of air and water pollution.
Even with these problems, the authors conclude that Russian health
status may improve if basic public health problems are addressed. Adequate public
financing, improved standards of education in all fields of health education, and adoption
of European Region World Health Organization Health-for-All Targets are needed.
The nutritional status of the elderly in Russia, 1992 through 1994. B.M. Popkin, N. Zohoori, and A. Baturin. American Journal of Public Health 86 (March 1996): 355-60.
To date, Russian economic reform has had no major adverse effects on the nutritional status of the elderly population overall.
A 2-year survey of 2,932 persons age 60 and older found that those living alone fared better than those living with families. A modest shift to diets lower in fat affected only a few seriously. More underweight elderly gained weight than lost. Those under 70 and underweight did not have further significant weight loss. Generally, weight distribution of elderly Russians is close to that of elderly Americans, despite reduced spending on nutrition.
By 1994, the poverty level for this group was higher than in 1992 and 1993. For this reason, the researchers recommend that the health and welfare of this group be monitored continuously.
The first year of hyperinflation in the former Soviet Union: Nutritional deprivation among elderly pensioners, 1992. D. Rush and K. Welch. American Journal of Public Health 86 (March 1996): 361-67.
In a 1992 survey of 2,281 urban elderly pensioners, researchers found that 50 percent of the respondents reported a weight loss of 5 or more kilograms in the 6 months prior to the survey.
The majority of respondents, 75 percent, were women. Only 19 percent were still married, as compared to 70 percent of the men. About 57 percent of all respondents reported not having enough money to buy food. Forty percent were eating less than a half kilogram of meat per week; 50 percent consumed less than a half kilogram of fruit; and about one-third consumed less than a liter of milk and 2 kilograms of bread. Weight loss was significant among this group and those with concurrent illness. Thirty-nine percent could not afford to buy medicines they needed. For both men and women, there were strong and significant relationships between weight loss and economic conditions.
The researchers point out that in the year this survey was undertaken,
deaths among this age group increased dramatically, by as much as 15 percent. They suggest
that similar studies need to be made to determine whether economic conditions improve for
those elderly on fixed and declining incomes when they do for the general population.
A multisite field test of the acceptability of physical activity counseling in primary care: Project PACE. B.J. Long, K.J. Calfas, W. Wooten, et al. American Journal of Preventive Medicine 12 (March/April 1996): 73-81.
The Physician-based Assessment and Counseling for Exercise (PACE) program was found to be a potentially important part of the national effort to enhance adults' physical activity, as outlined in the Healthy People 2000 objectives.
Twenty-seven primary care providers at four diverse sites participated
in the multisite field test. Primary care providers and office staff were trained in the
use of PACE, which promotes the adoption and maintenance of physical activity in adults.
The providers' evaluations of the training session were almost uniformly positive. The
three most important barriers to physical activity counseling were lack of time,
reimbursement, and support staff. The providers found that only 35 percent of staff
members were able to adapt to the program without difficulty, although 80 percent of the
staff thought the implementation of PACE went well. Among the patients, self-reported
physical activity increased following PACE counseling. The contemplator patients (those
who did little or no exercise but were interested in becoming more active) were urged to
set realistic goals and taught problem-solving techniques for potential barriers.
Pregnancy, abortion, and birth rates among US adolescents-1980, 1985, and 1990. A.M. Spitz, P. Velebil, L.M. Koonin, et al. Journal of the American Medical Association 275 (April 3, 1996): 989-94.
Pregnancy and birth rates for U.S. adolescents continue to be the highest in the developed countries. Increased efforts are needed to prevent these adolescent pregnancies, 95 percent of which are unintended.
The total estimated rates among U.S. adolescent girls aged 13 to 19
years old were based on census data and intercensal estimates. Between 1980 and 1990,
pregnancy and birth rates among adolescent girls 15 to 19 years old increased by 8 and 13
percent, respectively, but abortion rates remained quite stable. The pregnancy and
abortion rates for the adolescent girls in this group who were sexually active declined by
8 and 14 percent, respectively. For girls younger than 15, the pregnancy and birth rates
increased by 13 and 30 percent, respectively. In the second half of the decade, abortion
rates among this group declined by 13 percent while pregnancy rates remained nearly
stable, which contributed to a 26-percent increase in the birth rate. The researchers
concluded that, based on these data from the 1980s, the related public health goals for
the year 2000 are most likely unachievable.
Young black males and trauma: Predisposing factors to presentation in an urban trauma unit. D.T.J. Godbold, M. Grant, R. Rydman, et al. Journal of the National Medical Association 88 (May 1996): 273-75.
In an urban trauma unit, young black males were admitted at a rate disproportionately high compared to other racial and ethnic groups. Finding a solution to economic and educational inequities that affect this group may help to reduce the incidence of trauma.
Three hundred males between 18 and 40 years old who were admitted to the
Cook County Hospital trauma unit over an 8-week period during 1992 were given a
20-question survey. The survey covered type of trauma, demographic data, educational
background, employment status, and family educational background. A majority of the
patients, 87 percent of whom were black, were victims of penetrating trauma (53.2 percent)
or blunt trauma assault (33.5 percent). The highest unemployment rate was found among the
victims of these two assaults. Among all patients, 66 percent reported that there was an
adult male in the house while they were growing up; 93 percent reported the presence of
the biological mother. There was a significant correlation between the young black male
presenting to an urban trauma unit and unemployment and low educational level. Households
run by single-parent mothers and young black males presenting to urban trauma units also
showed a significant correlation.
Personal health-risk predictors of occupational injury among 3,415 municipal employees. B.G. Forrester, M.T. Weaver, K.C. Brown, et al. Journal of Occupational and Environmental Medicine 38 (May 1996): 515-21.
In a historical cohort study of municipal employees, the risk of occupational injury was found to be significantly associated with nonoccupational risk-taking behavior.
The Good Health Program for city employees in Birmingham, AL, guided by the Healthy People 2000 objectives, used periodic health-risk appraisals and screenings, citywide campaigns and contests, monthly health-promotion messages, and quarterly newsletter articles as components of its approach to changing behavior. The study population was 3,415 workers who took part in medical screenings in 1992 and 1993. Among these workers, nonoccupational risk-taking behavior was associated with increased occupational injury. This finding might suggest that persons who engage in risk-taking behavior continue that pattern at work, or that risk-takers may be assigned to or volunteer for jobs with greater risk of injury or illness. Men had an increased risk of occupational injury, even when controlling for nonoccupational risk-taking behaviors, smoking, and job type. Cardiovascular disease risk and psychosocial risk factors did not raise the risk of occupational injury. Further studies should be done to better define the factors associated with increased risk of injury and to evaluate interventions intended to decrease risk-taking behaviors that occur at work.
Worker participation in an integrated health promotion/health protection program: Results from the Well-Works project. G. Sorensen, A. Stoddard, J.K. Ockene, et al. Health Education Quarterly 23 (May 1996): 191-203.
Researchers found worksites to be potentially important channels for disease prevention and health promotion efforts in this cancer prevention intervention.
Employees (n=2,578) at 24 worksites participated in the WellWorks
program in Massachusetts. The study examined the workers' participation in health
promotion and disease prevention programs and whether the workers believed that management
made changes to reduce potential occupational exposures. Participation in program
activities ranged from 34 percent for smoking cessation to 49 percent for nutrition
activities. Participation in any intervention was significantly associated with perceived
employer changes to reduce occupational exposures. Blue-collar workers were less likely
than white-collar workers to participate in health promotion activities, but they were
more likely to participate in programs related to occupational exposures. Collaboration
between health promotion and health protection efforts may offer opportunities for
reaching blue-collar workers, for whom health promotion programs are least effective.
Effect of organization-level variables on differential employee participation in 10 Federal worksite health promotion programs. C.E. Crump, J.A. Earp, C.M. Kozma, et al. Health Education Quarterly 23 (May 1996): 204-23.
Participation in worksite health promotion programs remains low, even among those at greatest risk. In a study of Federal health promotion programs, researchers found that policy and environmental conditions that support health are necessary for individual behavior change.
Researchers gathered quantitative data from an employee survey (n=3,388)
of 10 Federal agencies and qualitative data from individual interviews and focus groups to
determine whether organizational context and implementation process affected participation
in health promotion and disease prevention programs. The average percentage of employees
participating in agency-supported fitness programs was 17 percent, with a range of 5 to 27
percent across all 10 agencies. For health risk assessment programs, the average
percentage of employees participating was 40 percent, with a range of 17 to 72 percent.
Two agencies had more than 60 percent of their employees participating in the health risk
assessment programs. More employee participation in fitness activities was found in
agencies that did a better job of reducing barriers to participation or marketing their
program. Employees participated in agency-supported programs when the manager and
coworkers supported health promotion and disease prevention activities. Minority employees
and those in lower level jobs participated more when the agencies had a more comprehensive
program structure, engaged in more marketing activities, gave more time off, or had
on-site facilities.
The impact of edentulousness on food and nutrient intake. K.J. Joshipura, W.C. Willett, and C.W. Douglass. Journal of the American Dental Association 127 (April 1996): 459-67.
Male health professionals who are edentulous (toothless) eat less healthy diets than men with teeth. These findings could have implications for the risks of cancer and cardiovascular disease.
From the Health Professionals Follow-Up Study, 49,501 males (58 percent dentists) were recruited to participate in this study. These men were sent questionnaires about 131 food items and supplements and asked how often they consumed the food over the past year.
Researchers calculated nutrient intakes and daily intake of fruit and
vegetables. Participants with more teeth generally consumed fewer calories, more
vegetables, fiber, and carotene, and less cholesterol and saturated fat. The greatest
difference between dentate and edentulous respondents involved hard-to-chew foods such as
apples, pears, and carrots, which are most likely to be affected by tooth loss. No major
differences were detected in the consumption of total fruit and vitamin C. Analysis of
data by profession showed more differences in diet between edentulous men and men with 25
or more teeth among nondentists. After adjusting for age, profession, exercise level, and
smoking status, the mean differences between the dentate and edentulous groups were small,
but the investigators believe the differences are likely to be higher in the general
population.
Physical activity and stroke incidence in women and men: The NHANES I Epidemiologic Follow-up Study. R.F. Gillum, M.E. Mussolino, and D.D. Ingram. American Journal of Epidemiology 143 (May 1, 1996): 860-69.
Risk of stroke may be reduced by regular physical activity in both women and men.
The study group was the National Health and Nutrition Examination Survey
I (NHANES), from which 5,081 white persons and 771 black persons remained for analyses
after exclusions. Nonfatal and fatal incident cases of stroke were the main outcome
measure. The outcomes were obtained from death information coded from death certificates
and from discharge diagnoses from hospital and nursing home records during the followup
period (1971 through 1987). There were 249 incident cases of stroke found in white women,
270 in white men, and 104 in blacks. Self-reported sedentary behavior was associated with
an increased risk of stroke for all groups. The association was particularly strong for
white women aged 65 to 74 years old, even after controlling for risk factors such as age,
smoking, history of diabetes, history of heart disease, education, systolic blood
pressure, total serum cholesterol, body mass index, and hemoglobin concentration. An
elevated resting pulse rate was not an independent risk factor for whites, but it was for
blacks.
Prior to use of estrogen replacement therapy, are users healthier than nonusers? K.A. Matthews, L.H. Kuller, R.R. Wing, et al. American Journal of Epidemiology 143 (May 15, 1996): 971-78.
In a prospective study, the subsequent users of estrogen replacement therapy (ERT) had a better cardiovascular risk profile before menopause than nonusers of ERT.
The study population was 541 premenopausal women who were evaluated for
cardiovascular risk factors and psychosocial characteristics. After about 8 years, 355
women became postmenopausal, and 157 women reported ERT use during the study period. The
women had telephone interviews to determine eligibility, followed by home interviews and
clinical evaluations. Compared to nonusers, ERT users were better educated (81 percent
with some college vs. 63 percent). Before ERT use, these women had higher levels of
high-density lipoprotein, leisure physical activity, and alcohol intake and lower levels
of blood pressure (systolic and diastolic), weight, and fasting insulin. These women also
reported more awareness of their feelings, motives, and symptoms and exhibited more of the
traits of Type A behavior. The results of the study suggest that women who use ERT in the
early postmenopausal period have a better cardiovascular risk factor profile before
hormone use and when still premenopausal than nonusers of hormones.
Practice patterns of rural family physicians based on the American Diabetes Association standards of care. R.J. Zoorob and A.G. Mainous III. Journal of Community Health 21 (June 1996): 175-82.
Rural family physicians do not consistently follow the American Diabetes Association (ADA) standards of care in caring for patients who have non-insulin dependent diabetes mellitus, one of the most common chronic diseases.
Twenty records of diabetic patients from each of five physicians in
Brown County, Ohio, were chosen randomly for the study. Data were collected using a
standardized collection protocol based on the ADA standards of medical care approved in
October 1988. All patients had blood pressure and weight measurements; 73 percent had a
skin examination; and 64 percent had a foot examination, despite the fact that foot
pathology is the most common cause of diabetic complications leading to hospitalization.
Patient records demonstrated 66 percent compliance with dietary counseling, and only 33
percent received counseling about exercise. None received dilated fundoscopic
examinations. While 96 percent of patients received fasting blood sugar measurement and 70
percent urinalysis, considerably fewer had hemoglobin A1c measurement, lipids
measurements, and electrocardiograms.
Universal newborn hearing screening: Feasibility in a community hospital. M.T. Huynh, R.A. Pollack, R.A.J. Cunningham. Journal of Family Practice 42 (May 1996): 487-90.
To detect hearing loss, universal newborn hearing screening using transient evoked otoacoustic emissions (TEOAE) can be done in community hospitals. The detection and treatment of infants with sensorineural hearing impairment before 12 months of age is a goal of Healthy People 2000.
In a U.S. Air Force hospital, a team consisting of a family practice
physician, family medicine resident, audiologist, and four technicians was established to
perform and interpret TEOAE. The training process included attendance at Walter Reed Army
Medical Center, background reading, videotapes, discussion on the use of TEOAE, and
application of the course material. Between November 1, 1994, and May 31, 1995, 627
infants (98 percent) were screened before hospital discharge. Most of the infants passed
the test (90.4 percent). With a second test for those who failed, 11 (1.8 percent) were
referred for additional screening. These infants were found to have conductive hearing
loss (5), sensorineural hearing loss (1), normal hearing (4), or the results were pending
(1). The technicians were able to perform the TEOAE screening accurately and reliably.
These results point to parental education as a benefit of early detection of the babies'
hearing loss.
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