Sozial- und Praventivmedizin最新文献

Objective: To evaluate a single item instrument, the Global Activity Limitation Indicator (GALI), to measure long-standing health related activity limitations, against several health indicators: a composite morbidity indicator, instruments measuring mental health (SCL-90R, GHQ-12), physical co-morbidity and physical limitations (ADLs, SF-36).

Methods: Cross-sectional data (n = 9168) of the 2001-National Health Interview Survey in Belgium was used to compare the GALI with other health indicators across gender, age, educational attainment and language.

Results: Responses to the GALI were similar to responses to other indicators of physical limitations (Limitations in Activities of Daily Living (by severity or by number of limitations), the SF-36 physical domain), to an indicator of chronic physical comorbidity and to indicators of mental health. The probability of reporting absence of long-standing activity limitation with the GALI was high in subjects without physical limitations or physical or mental conditions. This probability decreased as the severity or number of limitations, the number of physical or mental conditions increased.

Conclusions: The GALI performs appropriately against other health indicators and appears to reflect long-standing activity limitation associated with both mental and physical conditions.

Objective: To examine trends in ambulatory care utilization when individuals face almost no financial barriers to health care.

Methods: Observational study of insurance data. Adults with minimal deductible were included. Ambulatory care visits and costs were measured from 1997 to 2002.

Results: Mean ambulatory care costs/insuree increased from 1292.- to 1790.- CHF, corresponding to higher increases in drug costs (+61.7 %) than services costs (+24.3 %). The proportion of visits to generalists decreased while those to hospital outpatient services increased.

Conclusions: In a demographically stable population of insurees, increases in ambulatory care costs were due neither to growth in physicians' visits nor to increasing physicians' fees per act, but to what was included in or prescribed during the visits.

Objectives: To assess inequalities in mortality from external causes by the level of education and the place of residence during the period of socio-economic transition in Lithuania.

Methods: Information on deaths, place of residence, and the level of education of persons aged 25 and older was derived from the National Database of Lithuania and censuses for 1989 (n=3537) and 2001 (n=4790).

Results: Mortality from external causes of Lithuanian urban and rural populations was strongly associated with the level of education. Educational inequalities increased throughout the period of socio-economic transition. In urban areas, mortality among the least educated population was 3.20 times higher in 1989 and 3.37 times higher in 2001, compared to those with university-level education. In rural areas the educational mortality rate ratios reached 3.47 and 4.33, respectively. The greatest educational inequalities were observed in suicide mortality, especially among males.

Conclusions: The results of this study disclosed increasing inequalities in mortality from external causes. Less educated populations, especially in rural areas, should receive particular attention in the development of strategies for the prevention of mortality from external causes.

Objectives: To develop and test a counselling programme based on the Transtheoretical Model of behavioural change, for promoting exercise in people over the age of 65.

Method: The sample (n = 448) consisted of women and men aged between 65 and 92, recruited from Swiss GPs' practices between 2000 and 2004. After a baseline measurement (T1) and an initial counselling session, they received two counselling sessions, followed by a 12-month follow-up (T2). Changes in exercise behaviour were recorded by means of stage classification and the time spent on everyday moderate-intensity activities that increase the breathing rate.

Results: At T1 there was a tendency for women to be less physically active than men. T1 to T2 the proportion of inactive people fell from 12.2% to 4.2%, and the proportion of people sufficiently active rose from 19.0 % to 31.3 %. The changes in stage were significant in both men and women. At T2 more than half of the participants in the study spent more time exercising.

Conclusions: The results indicate that, with counselling, the exercise behaviour of the elderly can be positively influenced over a 1-year period.

Objectives: To assess socioeconomic differences between towns with and without water fluoridation, and to compare dental caries levels among socioeconomic strata in fluoridated and non-fluoridated areas.

Methods: A countrywide survey of oral health performed in 2002-03 and comprising 34,550 children aged 12 years provided information about dental caries levels in 249 Brazilian towns. Socioeconomic indices, the coverage and the fluoride status of the water supply network of participating towns were also appraised. Multivariate regression models fitted the adjustment of dental caries levels and covariates to socioeconomic status and water supply. Inequalities in dental outcomes were compared in towns with and without fluoridated tap water.

Results: Better-off towns tended to present a higher coverage by the water supply network, and were more inclined to add fluoride. Fluoridated tap water was associated with an overall improved profile of caries, concurrent with an expressively larger inequality in the distribution of dental disease.

Conclusion: Suppressing inequalities in the distribution of dental caries requires an expanded access to fluoridated tap water; a strategy that can be effective to foster further reductions in caries indices.