L. L. Davidson

Low-income neighborhoods and the risk of severe pediatric injury: a small-area analysis in northern Manhattan.

OBJECTIVESnThe purpose of this study was to investigate the relationship between socioeconomic disadvantage and the incidence of severe childhood injury.nnnMETHODSnSmall-area analysis was used to examine socioeconomic risk factors for pediatric injury resulting in hospitalization or death in Northern Manhattan, New York, NY, during a 9-year period (1983 through 1991).nnnRESULTSnThe average annual incidence of all causes of severe pediatric injury was 72.5 per 10,000 children; the case-fatality rate was 2.6%. Census tract proportions of low-income households, single-parent families, non-high school graduates, and unemployment were significant predictors of risk for both unintentional and intentional injury. Among the socioeconomic factors considered, low income was the single most important predictor of all injuries; other socioeconomic variables were not independent contributors once income was included in the model. Compared with children living in areas with few low-income households, children in areas with predominantly low-income households were more than twice as likely to receive injuries from all causes and four and one half times as likely to receive assault injuries. The effect of neighborhood income disparities on injury risk persisted after race was controlled.nnnCONCLUSIONSnThese results illuminate the impact of socioeconomic disparities on child health and point to the need for injury prevention efforts targeting low-income neighborhoods.

The accuracy of self-reported healthcare resource utilization in health economic studies

OBJECTIVEnIndividuals recollections of the number and type of health service encounters are frequently required for health economic studies. We sought to establish whether the accuracy of self-reported healthcare resource utilization is a function of the duration of the recall period and the saliency of the health service encounter.nnnMETHODSnPatient recollections of a range of community services (general practitioner visits, community midwifery visits) and hospital services (accident and emergency attendances, hospital outpatient attendances, inpatient admissions) over 4-month and 8-month time periods were obtained from women participating in a randomized controlled trial. Comparisons were made with healthcare resource utilization data extracted from medical records. Where significant differences were identified between the self-reported and medically recorded data, a multivariate linear regression model was constructed to identify the factors associated with underreporting and overreporting of healthcare resource utilization.nnnRESULTSnThe study revealed a tendency to underreport community service utilization, which appears to be exacerbated when the recall period is extended. A number of sociodemographic and clinical factors significantly associated with this tendency to underreport community service utilization were identified. The self-reporting of hospital service utilization over varying periods of recall was found to be more accurate.nnnCONCLUSIONnIt is important that economic analysts establish optimal methods for estimating resource utilization quantities within health economic analytical designs. In particular, greater emphasis should be placed on extracting information on community service utilization from medical records or routine health service information systems.

The effects of a natural disaster on child behavior : evidence for posttraumatic stress

OBJECTIVESnA prospective study of children examined both before and after a flood disaster in Bangladesh is used to test the hypothesis that stressful events play a causal role in the development of behavioral disorders in children.nnnMETHODSnSix months before the disaster, structured measures of selected behavioral problems were made during an epidemiological study of disability among 2- to 9-year-old children. Five months after the disaster, a representative sample of 162 surviving children was reevaluated.nnnRESULTSnBetween the pre- and postflood assessments, the prevalence of aggressive behavior increased from zero to nearly 10%, and 45 of the 134 children who had bladder control before the flood (34%) developed enuresis.nnnCONCLUSIONSnThese results help define what may be considered symptoms of posttraumatic distress in childhood; they also contribute to mounting evidence of the need to develop and evaluate interventions aimed at ameliorating the behavioral and psychological consequences of childrens exposure to extreme and traumatic situations.

Studies of children in developing countries. How soon can we prevent neurodisability in childhood

Neurodevelopmental disability is a functional limitation due to a neurological disorder with an onset early in life and occurs across a range of domains: cognition, movement, seizure disorders, vision, hearing, and behaviour. Disability can occur within a single domain or involve more than one domain in the case of multiple disabilities. Disabilities can be caused by a variety of etiological insults, many of which are preventable at a primary, secondary, or tertiary level. Neurodevelopmental disabilities are an important but largely unaddressed problem in low-income countries (Durkin et al. 1991). For this paper, the term ‘developing countries’ includes low-income countries with few professional and institutional health resources and inadequate infrastructure to deliver known effective preventive or rehabilitative measures nationally. It is understood that higher-income countries may also fail to address the challenges faced in preventing disability or in effective rehabilitation. Though many of the causes of neurodevelopmental disabilities in children in developing countries are identical to those in developed countries, there are causes which have an impact solely in developing countries such as cerebral malaria or trachoma. The prevalence of a disabilitywill increase or decrease in any given population depending on a variety of factors: for example, age distribution of the population, prevalence of the causal agents, availability of preventive measures or of initial treatment, and the longevity of those at risk. As a result, the epidemiology of neurodevelopmental disabilities show a markedly different pattern in developing countries than in the developed world.