Labor-force participation patterns of older self-employed workers

Self-employed persons work in a less constrained environment than do most wage-and-salary employees. Generally they are not subject to compulsory retirement nor are they affected by institutional rules concerning labor supply. Data from the 1969 and 1971 interviews of the Retirement History Study show that the labor supply and retirement patterns of the self-employed are distinct from those of other workers. The self-employed (espeically "career" self-employed) nearing retirement age are less likely to be out of the labor force, and those who continue in the labor force have a wider variation in the number of hours worked per year. Downward flexibility in hours (the option for gradual retirement) may be an extremely valuable aspect of self-employed status, and one wonders whether other older workers would also choose this pattern if more flexible opportunities were available. Despite these differences, labor-supply decisions of the self-employed are found to be influenced by many of the same factors that affect the rest of the workforce--health, eligibility for social security and pension benefits, the wage rate, and the flow of asset.

Housing and health in the process of cultural adaptation: a case study among jungle and highland natives of Ecuador

A household survey was undertaken among four Indian groups in Ecuador. Family housing conditions were related to dwelling development (from traditional to modern type) in data obtained from 727 family interviews. Measurements of the physical characteristics of the shelter completed the study. It is shown that: 1. The protection against the elements (temperature and humidity) is best in traditional houses and becomes worse with development; 2. The floor area per person is the highest in the traditional and the lowest in the modern houses; 3. Development does not mean improvement of domestic equipment; 4. New construction materials have many disadvantages when compared with traditional ones; 5. The more intensely a person is exposed to cross cultural influence the more likely he is to build a modern house. The findings are used to develop the argument that housing related health education should be adapted to the environment and the culture of the local population.

The influence of age on peripheral lymphocyte count in men: a cross-sectional and longitudinal study

The peripheral lymphocyte count was determined on 436 carefully screened healthy male participants of the Normative Aging Study on three successive determinations over a ten year period. Cross-sectional analysis revealed no significant differences in absolute lymphocyte count between the age groups 23 to 44, 45 to 54, and 55+ years. Longitudinal analysis also showed no significant change in absolute lymphocyte count over the study period. These results indicate that absolute lymphocyte count in healthy men does not change with age.

The differential usage of services by impaired elderly

Why do some clients use institutional services, while other, with comparable impairment, use community based services? To answer this question, a matching procedure paired clients from the two types of service provision. Sixty-six clients, ages 62 and over, were matched for functional ability as rated on a 6-item ADL scale (Katz, et al., 1970). A discriminant function analysis was performed, with the setting of service provision as the criterion variable. The results indicated that the institutional group was more likely than their community counterparts: (a) to have had previous service contact with other service providers; (b) to have less support available within the community setting from family members or friends; (c) to be more impaired in the areas of mental health and social resources.

Food habits and nutritional status of agricultural migrant workers in Southern Brazil

A new class of migrant workers, commonly known as "Boia-Frias", is rapidly growing in the periurban slumbs (favelas) of Brazil. In 1978 a collaborative study was undertaken to assess the food habits and nutritional status of 100 migrant worker families of Vila Recreio, a typical Boia-Fria settlement near Ribeirao Preto in the state of Sao Paulo. The findings of this survey revealed that the traditional diet of Boia-Frias is nutritionally inadequate both in quality and quantity. Their rice and bean-based diet lacks sufficient variety because of the infrequent use of fresh fruits and vegetables, which are available locally, and of supplemental amounts of protein-rich foods of animal origin. Empty-calorie foods such as carbonated drinks and alcoholic beverages are consumed freely; and starchy foods, traditionally used in the North and Northeast of Brazil, are used commonly as weaning foods. Although dietary practices of pregnant and lactating women are poor, breast-feeding is still practiced by most mothers. The biochemical analysis of blood samples did not indicate major subclinical deficiencies except low hematological values and low plasma vitamin A concentrations in about 25% of the population examined. Plasma cholesterol and plasma vitamin E values were found to be normal. However, anthropometric examinations revealed clear signs of malnutrition and/or undernourishment, which likely impairs their capacity for physical work and adversely affects their overall health.

Geriatric day care and homemaker services: an experimental study

The purpose of this study was to examine the impact of geriatric day care and homemaker services on patient outcomes. Patients were randomly assigned to receive the experimental services in three study samples. In comparing outcomes between the experimental and control groups, it was found that there were significant differences in physical functioning and activity level for the day care samples, in physical functioning and contentment level for the homemaker study sample, and in all of these outcome measures for the combined services group. Among users of the experimental services, increased use of the services was associated with improved outcomes of care. Multivariate analysis of data showed that factors other than the use of the experimental services were more effective in explaining variation in outcomes. Significant factors that affected all four outcome measures in both the day care and homemaker study were primary diagnosis, impairment prognosis, and number of inpatient hospital days.

Life events, 17-OHCS measures, and psychological defensiveness in relation to aid-seeking

Professional aid-seeking for medical or psychological reasons was measured in 80 firefighters for a retrospective period of six months and a prospective period of eight weeks. The magnitude of life stress events, 24-hour urine 17-OHCS levels, and MMPI K-Scale scores were compared between those subjects who had sought professional aid and those who had not. The measured values did not differ significantly between groups and were, in fact, well within normal limits for all subjects tested. Analysis suggests that implied relationships between stress and illness are questionable in low-stress, low-maladjustment populations. These data lend support to the concept of a threshold effect for influence of life change on subsequent illness manifestation.

Acute water shortage and health problems in Haiti

During a severe drought Port-au-Prince, Haiti, lost hydroelectric power for 10 weeks. This led to water shortages in areas of the city dependent on water supplied from electrically driven pumps. In a study of the impact of water restriction on disease, 400 families were randomly selected from two urban areas differentially affected by the water shortage. Disease in children was found to be related to quantity of water used, socioeconomic status, employment of head of household, and family size. The methods used in this study are recommended for the investigation of the relationship between water quantity and health.

Methodological and practical issues related to shiftwork research

This paper cites inconsistencies in the current literature regarding the health impact of shiftwork and suggests that these disparities may be attributed, in part, to shortcomings in the nature and reporting of cross-sectional field research. Selected methodological (e.g., differential accretion, cross-over) and practical (e.g., definition of independent and dependent variables) problems in the design and communication of shiftwork investigations are discussed and strategies are provided for their solution.

Assessment of fitness for surgical procedures and the variability of anaesthetists' judgments

Ten anaesthetists were asked to make judgments on fitness for elective operation on data derived from 200 patients. The extent of their agreement was measured using a kappa statistic, and clusters of anaesthetists who agreed well with each other were identified. Using an alternative technique, the "true" fitness category of each patient was estimated using a maximum likelihood method which estimated the error involved in making judgments on limited amounts of information. It was possible to compare the performance of each anaesthetist against the consensus and to measure deviation on an "optimism--pessimism" continuum. A simple questionnaire predicted fitness for operation by all 10 anaesthetists in 96% of cases.

Physical illness and psychosis

One hundred psychotic patients referred to a consultation service in a general hospital were compared with 50 psychotic patients without physical illness in a psychiatric unit. Background, mental and cognitive state were evaluated. In addition to providing a list of likely causes of cerebral dysfunction in such a sample, the study revealed an increased incidence of prior depression in those with cerebral dysfunction, and identified a group where psychosocial factors appeared more significant than cerebral dysfunction in determining the psychosis. The various ways in which a psychosis can be associated with a physical condition, and the various forms that it can take even when cerebral dysfunction is present, are discussed.

Measuring health status in arthritis. The arthritis impact measurement scales

A multidimensional index that measures the health status of individuals with arthritis has been developed. The Arthritis Impact Measurement Scales (AIMS) are a combination of previously studied and newly created health status scales which assess physical, emotional, and social well-being. The self-administered AIMS questionnaire has been pilot tested in a mixed arthritis population. Results indicate that the instrument is practical and that it generates scalable, reliable, and valid measures of both aggregated and disaggregated health status. The AIMS approach to health status measurement should prove useful for evaluating the outcomes of arthritis treatments and programs.

Continuity of care

Continuity of care is of value only to the extent that it has an impact on the outcome of care, the prevention or reduction of physical, mental, or social disabilities, the satisfaction of patients, and the costs of care. It is important that research studies include patients with a broad range of social characteristics and that costs as well as health care benefits be measured. An accountability model describing the contributions of physicians, health care institutions, patients, and the local community to health outcomes is recommended. The following three principles are outlined for the evaluation of health care: (1) determine the patient's health status before and after care, (2) use appropriate measures of health outcomes, and (3) consider potential effects of factors extrinsic to medical care.

Voluntary risks to health. The ethical issues

The discovery that health status is affected by personal life-styles and apparently voluntary health risks poses new problems. It has potential impact on clinical practice, health insurance, and theories of health and disease. Five major problems need attention. First, are these health-risk behaviors really voluntary? Five responses are explored: several other models (the medical, psychological, social structural, and multicausal models) all challenge the assumption of voluntary behavior. Second, are some sufficiently in the public interest that they ought to be subsidized? Third, does justice require that persons bear the costs of truly voluntary health risks? Fourth, what policies should apply to cost-saving, health-risk behavior? Finally, does the voluntary health-risks theme make life too rational and calculating? These issues must be dealt with in future health planning and clinical decision making.