Rosa Gofin

Indicators of social class: A comparative appraisal of measures for use in epidemiological studies

Various indicators of social class were compared in a community health survey in Jerusalem in order to appraise their value in detecting associations with health characteristics. Correlations among the indicators and between them and selected health-relevant variables were measured. The results suggested that there was little to choose between the occupational scales tested (an adaptation of the British Registrar-Generals scale, a prestige scale, and a socio-economic status scale) for use as general indicators of social class in epidemiological studies, as the correlations between them were very high and the patterns of their correlations with the health variables were very similar. Correlations with some health variables became weaker when less detailed occupational data were used. Other indicators of social class (education, family income, household crowding, an authority rating and an amenities score) were not strongly correlated with occupation, and there were differences in their associations with the health variables, indicating that conclusions about the relationship between health and social class are not insensitive to the measure used. Despite the discrepancies, the patterns of associations with the health measures were broadly similar for occupational scales, education and income, suggesting that if a single measure is to be used there may for some purposes be little to choose between these major indicators. The fairly low correlations among these different indicators of social class suggest that there may be considerable gains from using more than one measure, so as to increase the chance that an association with social class will be detected, to permit appraisal of independent effects and important interactions between indicators, and to increase the overall explanatory or predictive power of the model. The choice of indicators should be determined by practical considerations and by the conceptual framework with respect to the social-class relationships of the health characteristics under study.

Epidemiological studies on head lice infestation in Israel. I. Parasitological examination of children.

ABSTRACT: Of 3,079 children in a medium‐sized community near Jerusalem, 11.2% were found to be infested with living lice and eggs and another 23.4% had only nits. Boys and girls were equally infested. The incidence of infestation was highest among children4–11 years of age. About 78% of the infested children had from one to ten lice. Approximately 80% of the infested children had nits that were 2–5cm away from the scalp. Boys with medium length hair and girls with short hair showed the highest incidence of lice infestation. Children with brown and red hair were more infested than those with black and blond hair. Boys and girls with straight and wavy hair were more infested than those with curly and frizzy hair.

Media Health Literacy (MHL): development and measurement of the concept among adolescents

Increasing media use among adolescents and its significant influence on health behavior warrants in-depth understanding of their response to media content. This study developed the concept and tested a model of Media Health Literacy (MHL), examined its association with personal/socio-demographic determinants and reported sources of health information, while analyzing its role in promoting empowerment and health behavior (cigarette/water-pipe smoking, nutritional/dieting habits, physical/sedentary activity, safety/injury behaviors and sexual behavior). The school-based study included a representative sample of 1316 Israeli adolescents, grades 7, 9 and 11, using qualitative and quantitative instruments to develop the new measure. The results showed that the MHL measure is highly scalable (0.80) includes four sequenced categories: identification/recognition, critical evaluation of health content in media, perceived influence on adolescents and intended action/reaction. Multivariate analysis showed that MHL was significantly higher among girls (β = 1.25, P < 0.001), adolescents whose mothers had higher education (β = 0.16, P = 0.04), who report more adult/interpersonal sources of health information (β = 0.23, P < 0.01) and was positively associated with health empowerment (β = 0.36, P < 0.0005) and health behavior (β = 0.03, P = 0.05). The findings suggest that as a determinant of adolescent health behavior, MHL identifies groups at risk and may provide a basis for health promotion among youth.

Incidence and impact of childhood and adolescent injuries: a population-based study.

BACKGROUND The study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries. METHODS Telephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities. RESULTS Six months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents. CONCLUSION A relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.

The Jerusalem Experience: Three Decades of Service, Research, and Training in Community-Oriented Primary Care

Community-oriented primary care (COPC) developed and was tested over nearly 3 decades in the Hadassah Community Health Center in Jerusalem, Israel. Integration of public health responsibility with individual-based clinical management of patients formed the cornerstone of the COPC approach. A family medicine practice and a mother and child preventive service provided the frameworks for this development. The health needs of the community were assessed, priorities determined, and intervention programs developed and implemented on the basis of detailed analysis of the factors responsible for defined health states. Ongoing health surveillance facilitated evaluation, and the effectiveness of interventions in different population groups was illustrated. The centers international COPC involvement has had effects on primary health care policy worldwide.

COMMUNITY-ORIENTED PRIMARY CARE AND PRIMARY HEALTH CARE

Nowadays there is a renewed interest in the role of primary care as an essential component of the delivery of health care. Cueto’s article on the role of the World Health Organization (WHO) in the emergence of primary health care1 is timely indeed and stimulates discussion about this dimension of health care. We wish to direct attention to an approach not mentioned in Cueto’s article that is taught, practiced, and written about extensively—the community-oriented primary care (COPC) model. The recent application and evaluation of COPC in various countries was reported in several articles published in the November 2002 issue of the Journal. The conceptual roots of COPC were introduced and developed in the 1940s by Sidney Kark and Emily Kark in a rural area of South Africa. As family physicians, the Karks implemented a comprehensive approach to care, taking into account the socioeconomic and cultural determinants of health, identifying health needs, and providing health care to the total community. Their pioneering work, integrating preventive and curative care with significant community involvement, created a service network of a kind scarcely known then in that continent, with more than 40 community health centers established in different regions of the country.2 The Karks and their team developed this approach further at the Community Health Center of the Hadassah School of Public Health and Community Medicine in Jerusalem.3 In Sidney Kark’s book Epidemiology and Community Medicine (published in 1974, before Alma Ata), he speaks of “community medicine and primary health care as a unified practice.”4(p7) This approach, which later was denominated COPC,5 is considered an expression of the Alma Ata spirit.6,7 In our COPC teaching,8 we have had frequent discussions with international public health students, mainly Africans, concerning the similarities and differences between COPC and the primary health care approach of WHO. As an explicit expression of the role played by COPC in the development of the WHO primary health care approach, Litsios notes (also in the November 2004 issue of the Journal) that there is evidence of “many similarities between primary health care and Kark’s work in Africa.”9(p1890) The renewed interest in primary care is particularly appropriate because primary care is the component of health services that addresses most of the health problems arising in a community, and when it is enhanced by a community orientation, it can be considered public health at the local level.10

Intentional injuries among the young: presentation to emergency rooms, hospitalization, and death in Israel

PURPOSE To study the incidence and outcome of intentional injuries requiring emergency room (ER) care among children and adolescents in a national sample. METHOD The population included 0- to 17-year-olds who presented to the ER for injuries in 23 hospitals over a 1-year period. A 6% to 9% random sample of days was selected in each hospital, and for each selected day the relevant ER record was reviewed for cause, nature, and outcome of injuries and sociodemographic information. RESULTS The annual incidence for intentional injuries resulting in ER visits was 19.6 in 10,000 children and adolescents aged 0 to 17 [95% confidence interval (CI) 17.4-21.8 in 10,000]. Fights/assaults constituted 54.1% of the presentations, abuse and rape, 10.3%, and self-inflicted injuries, 10.8%. Overall rates were higher among 10- to 17 year olds than at younger ages. The rates were higher among boys than girls for fights/assaults and abuse, whereas attempted suicide and rape were three times higher among girls than boys. Nearly twice as many Jewish children and adolescents presented to the ER for intentional injuries than Arab children and adolescents, with the ratio becoming even greater for attempted suicide. Of all the intentionally injured, 21.7% were hospitalized. The mortality rate was 1.1 in 100,000 (95% CI =.7-1.7/100,00) with no significant gender difference observed. No cases of suicide were reported for the Arab population. CONCLUSIONS Adolescents aged 10 years and older are at higher risk for intentional injuries than younger children. The ethnic differences evident in this study, especially for attempted and completed suicide, may be real or the result of differential disclosure of information owing to sociocultural norms or differential recording by health professionals.

Fighting among Jerusalem adolescents: personal and school-related factors.

PURPOSE To study the prevalence of physical fighting among youth and its association with personal and school-related factors. METHODS Pupils in the 8th and 10th grades (n = 1182, ages 13-16 years) in 11 Jerusalem secular and religious schools anonymously completed the World Health Organization questionnaire from the Health Behavior in School Children study. The unit of analysis was defined as the number of times the student was involved in physical fighting during the past year. The independent variables studied were sociodemographic characteristics, personal, and school-related factors including teachers, peers, and family. RESULTS Fighting at least once was reported by 76% of boys and 26% of girls; 6% of boys who were involved in fights at least once and 16% more than once required medical treatment. For boys, bullying others, poor health and mental health score, and perception of teachers that the pupil was a below-average student significantly increased the odds ratio (OR) for fighting more than once in the past year. Among girls, poor mental health, poor parental support on school matters, bullying, and being bullied by others increased the OR for fighting. CONCLUSIONS Fighting is a highly prevalent behavior among adolescents irrespective of their socioeconomic background. Determinants differ by gender, and intervention programs should focus on the gender-specific determinants.

Motor ability: protective or risk for school injuries?

The study aims were to assess the independent contribution of motor ability to the incidence of school injuries. The study included 2057 pupils in grades 3-6 of primary schools in a city in the north of Israel. A surveillance system gathered information about injuries that occurred on school premises or during school related activities and required medical treatment or caused limitation of usual activities. Children provided information on sensation seeking, self-appraisal of health, academic performance, physical activity, and dominant hand; anthropometric measurements and motor ability tests were performed. The incidence of injury events was 4% (95% CI=3.2-5.0). Injuries increased with increased balance and agility, but there were no differences according to reaction time. No other study variables were associated with the incidence of injuries. Our findings of an increase in the incidence of injuries with better motor ability may express differences in exposure to risk situations between children with better and poorer motor abilities.

Injury prevention program in primary care: process evaluation and surveillance.

OBJECTIVES: To carry out process evaluation and surveillance in a community oriented primary care program for injury prevention among children 0-2 years old (n = 306). SETTING: Mother and child health clinic in a defined area of Western Jerusalem. METHODS: An injury prevention program was integrated into the routines of the mother and child health clinic. The program consisted of injury surveillance and counselling using a developmental approach, regarding car safety and the prevention of falls, burns, suffocation, poisonings, cuts, drowning, and electrocution. Process evaluation and surveillance were based on records integrated into the childs personal file in the clinic. RESULTS: Process evaluation indicated that counselling coverage was 73% in the 0-5 month age group and decreased to 48% in the second year of life. The mean number of topics discussed with the parents was 6.6 (out of nine) for the 0-5 months age group, 13.6 (out of 18) for the 6-11 month group, and 15.7 (out of 18) for those 1-2 years old. Injury surveillance activities were complete for 66% of the children, incomplete in 32%, and not done in 2%. CONCLUSIONS: The results indicate that it is feasible to integrate an injury prevention program into primary care, and that process evaluation is important in detecting problems and improving performance of the programs activities.