BackgroundRates of diseases and injuries and the effects of their risk factors can have substantial subnational heterogeneity, especially in middle-income countries like Mexico. Subnational analysis of the burden of diseases, injuries, and risk factors can improve characterization of the epidemiological transition and identify policy priorities.Methods and FindingsWe estimated deaths and loss of healthy life years (measured in disability-adjusted life years [DALYs]) in 2004 from a comprehensive list of diseases and injuries, and 16 major risk factors, by sex and age for Mexico and its states. Data sources included the vital statistics, national censuses, health examination surveys, and published epidemiological studies. Mortality statistics were adjusted for underreporting, misreporting of age at death, and for misclassification and incomparability of cause-of-death assignment. Nationally, noncommunicable diseases caused 75% of total deaths and 68% of total DALYs, with another 14% of deaths and 18% of DALYs caused by undernutrition and communicable, maternal, and perinatal diseases. The leading causes of death were ischemic heart disease, diabetes mellitus, cerebrovascular disease, liver cirrhosis, and road traffic injuries. High body mass index, high blood glucose, and alcohol use were the leading risk factors for disease burden, causing 5.1%, 5.0%, and 7.3% of total burden of disease, respectively. Mexico City had the lowest mortality rates (4.2 per 1,000) and the Southern region the highest (5.0 per 1,000); under-five mortality in the Southern region was nearly twice that of Mexico City. In the Southern region undernutrition and communicable, maternal, and perinatal diseases caused 23% of DALYs; in Chiapas, they caused 29% of DALYs. At the same time, the absolute rates of noncommunicable disease and injury burdens were highest in the Southern region (105 DALYs per 1,000 population versus 97 nationally for noncommunicable diseases; 22 versus 19 for injuries).ConclusionsMexico is at an advanced stage in the epidemiologic transition, with the majority of the disease and injury burden from noncommunicable diseases. A unique characteristic of the epidemiological transition in Mexico is that overweight and obesity, high blood glucose, and alcohol use are responsible for larger burden of disease than other noncommunicable disease risks such as tobacco smoking. The Southern region is least advanced in the epidemiological transition and suffers from the largest burden of ill health in all disease and injury groups.
Children of immigrants are a rapidly growing part of the U.S. child population. Their health, development, educational attainment, and social and economic integration into the nation's life will play a defining role in the nation's future. Nancy Landale, Kevin Thomas, and Jennifer Van Hook explore the challenges facing immigrant families as they adapt to the United States, as well as their many strengths, most notably high levels of marriage and family commitment. The authors examine differences by country of origin in the human capital, legal status, and social resources of immigrant families and describe their varied living arrangements, focusing on children of Mexican, Southeast Asian, and black Caribbean origin. Problems such as poverty and discrimination may be offset for children to some extent by living, as many do, in a two-parent family. But the strong parental bonds that initially protect them erode as immigrant families spend more time in the United States and are swept up in the same social forces that are increasing single parenthood among American families. The nation, say the authors, should pay special heed to how this aspect of immigrants' Americanization heightens the vulnerability of their children. One risk factor for immigrant families is the migration itself, which sometimes separates parents from their children. Another is the mixed legal status of family members. Parents' unauthorized status can mire children in poverty and unstable living arrangements. Sometimes unauthorized parents are too fearful of deportation even to claim the public benefits for which their children qualify. A risk factor unique to refugees, such as Southeast Asian immigrants, is the death of family members from war or hardship in refugee camps. The authors conclude by discussing how U.S. immigration policies shape family circumstances and suggest ways to alter policies to strengthen immigrant families. Reducing poverty, they say, is essential. The United States has no explicit immigrant integration policy or programs, so policy makers must direct more attention and resources toward immigrant settlement, especially ensuring that children have access to the social safety net.
The present study builds on past research that has found support for a conceptual model in which poverty is linked with adolescent psychological symptoms through economic stressors and impaired parenting. The present study examined this model in a sample of urban African American mothers and their adolescent children. In addition, an alternative hypothesis was examined: that exposure to community violence mediates the relation between poverty and psychological symptoms in urban youth. Limited support was found for a model in which poverty is linked with internalizing symptoms through exposure to community violence and with externalizing symptoms through economic stressors and inconsistent discipline. Interpretations, limitations, and directions for future research are outlined.
The major epidemiological investigations of hearing impairment, disability and handicap show that the elderly are the group most disabled by their hearing impairment. There is considerable debate concerning the most efficient way of reducing this inevitable burden of age-related hearing impairments in the next generation. Early fitting of 'targeted' individuals with hearing aids may help but there are a large number of methodological problems associated with conducting and evaluating such a programme of research (especially retrospectively). The logical prerequisite to early fitting as a means of reducing later disability is to ascertain the acceptability of and benefit given by intervention at this early stage. This study therefore set out to investigate the age/sex register provided by the primary physician (GP) as an appropriate base to identify candidates for early aid fitting among a sample of middle-aged patients (50-65 years) living in Roath, Cardiff. Of the 662 who replied to an initial contact letter (1050 were on the age/sex register), 21 already possessed hearing aids. After screening and examination 66 people were offered some form of management which was accepted by 43 during the course of the study. Aid use thereby increased from about 3% to over 9% in this middle-aged group. A 2 year follow-up indicated continued use of the aids, and benefit on a speech reception task was measured. The cost of detecting those who might benefit was calculated using a two-question 'paper and pencil' screen as the first step. A national programme for Wales would cost at least 188,000 pounds per annum at 1990 prices over an initial 5 year span if a criterion which aimed to find at least 45 dB HTL impairments over mid-frequencies was implemented. For a criterion of 35 dB the cost would be 378,000 pounds pa.
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