Consequences of Population Density and Size

The classical theory about effects of high residential density is "negative," stating that high density produces negative social attitudes and undesirable behaviors. Yet empirical re search usually finds density only weakly related to individuals' attitudes and behavior. A survey was conducted in Baltimore for three purposes: to test "negative" hypotheses for new dependent variables; to determine if negative density effects appear only when certain "buffers" are weak; and to test hypotheses about "positive" effects of density. Results show that large population size and feelings that an area is overpopulated produce frustrations about the environment. Objective density has some negative and positive effects, but it is less important than population size, subjective appraisal of population, and population composition. Compared to prior research, the special contributions of the Baltimore study are examination of (1) population size, (2) "positive" consequences of high density and large size, and (3) effects in three distinct residential areas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68954/2/10.1177_107808748001600202.pd

Profile of arthritis disability: II

Objective Arthritis is the most common chronic condition and the most common cause of disability among older US adults. We studied social participation, disabilities in many life domains, accommodations used (buffers), and accommodations needed (barriers) for US adults with arthritis disability compared with adults with disability from other conditions. Methods The data source is the National Health Interview Survey Disability Supplement Phase Two. Arthritis-disabled individuals named arthritis as the main cause of ≥1 disabilities. Other-disabled individuals named only other conditions as causes of their disabilities. We compared outcomes for the groups, taking sample weights and complex variances into account. Results Arthritis-disabled individuals get out and about less often than other-disabled individuals, but they manage to maintain active social ties. They have more disabilities of all types (personal care, household management, physical tasks, transportation, home, work), and the disabilities often cause fatigue, long task time, and pain. Despite this, arthritis-disabled individuals use less personal assistance than other-disabled individuals; they do use more equipment assistance. Arthritis-disabled individuals report more barriers in getting around outside their home and at their workplace. Conclusion The distinctive profile of arthritis disability includes extensive and uncomfortable disabilities, yet there are active management strategies to handle these disabilities. Problems away from home and at work should inspire engineers and planners to improve public access and equipment for persons with this high-prevalence disability.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/49515/1/21694_ftp.pd

Triggers of symptoms and health care

This article studies triggers of physical symptoms and health care on a daily basis. The data used are health diaries kept for 6 weeks by 589 adults in metropolitan Detroit. The results show that bad moods consistently trigger physical problems and health actions (medical drug use, medical care, lay consultation, restricted activity) for men and women of all ages. Negative events have small effects on these outcomes, sometimes acting as triggers, but sometimes as dampers. Physical malaise (feeling bad overall) is an especially strong trigger for symptomatic people to take health actions. Troubles of all kinds--bad moods, physical malaise, symptoms, negative events--tend to repeat from one day to the next. Yesterday's troubles help trigger symptoms and health care today, but they have less influence than today's troubles do. When troubles continue for 2 days in a row, this spurs people especially to seek professional help. Women tend to respond more predictably and simply to triggers than men do, and older people appear to be more sensitive and responsive to triggers. The results indicate that the social stress and health model, which typically considers the longrun of major life events and chronic mental and physical conditions, is also apt for the shortrun of daily negative events, bad moods and physical discomfort and symptoms.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25925/1/0000488.pd

Women, men, and osteoarthritis

Objectives and Methods. Gender differences in the prevalence and impact of arthritis are discussed, using data and analytic results from national health surveys. Results. Most cases of arthritis are osteoarthritis, an ancient disease that causes pain, physical dysfunction, and social disability, but not death. Arthritis prevalence rates rise sharply with age; it is the leading chronic condition in mid and late life. Women's rates exceed men's at all ages. Women's higher rates of disability and medical services for arthritis in the population are due mainly to higher prevalence. Among persons with arthritis, women are only a little more likely than men to be disabled or receive medical services. Persons with arthritis often have other chronic conditions as well (called comorbidity). Combining arthritis and visual problems gives a strong exacerbating push to disability. Conclusions. Because biomedical research emphasizes pathogenesis and therapies for fatal conditions, Americans' health future will become dominated by nonfatal ones, especially arthritis. I recommend a better balance and new orientation for arthritis research that stays true to older persons' health and disability experience.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37806/1/1790080404_ftp.pd

From sneezes to adieux: Stages of health for American men and women

This article traces health from daily symptoms to death for American (U.S.) men and women in three age groups 17-44, 45-64, 65+. How do leading problems change as our perspective shifts from daily symptoms to annual incidence and prevalence rates of diseases and injuries; then to problems that induce long term limitations; to conditions brought to physicians for care; to diagnoses for hospital stays; and finally to causes of death? We study the top 15 conditions in each of these stages of health. Young adults are bothered most by acute and chronic respiratory diseases, but deaths among them are due to diseases and violent injuries that seldom figure in daily life. Fatal chronic diseases become more prevalent in middle ages and spur professional care, but they rarely cause daily symptoms. For older people, life threatening chronic conditions stretch through all stages of health. Arthritis also becomes a dominant facet of symptoms, social limitations and ambulatory care. Men's and women's leading daily symptoms are very similar; so are their leading acute and chronic conditions, limiting conditions, diagnoses for health care and causes of death. What distinguishes the sexes is the rates, not the ranks, of health problems they suffer. We elaborate the iceberg of morbidity metaphor, as a device to highlight stage, age and sex differences in health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26454/1/0000542.pd

How physicians treat mentally distressed men and women

There is speculation that women receive different medical care than men because physicians have stereotyped views about women's symptoms and treatment preferences. This paper asks if men and women who visit physicians for mental distress receive comparable medical care and, if not, whether medical considerations or psychosocial ones explain the differences. Data are from a large national survey of ambulatory care visits in the United States. We find that women and men are equally likely to report mental distress as their main problem to physicians. Physicians determine that distressed men have mental disorders more often than distressed women. On the whole, distressed men and women receive similar numbers of diagnostic services, therapeutic services and dispositions for follow-up care. The kinds of services and dispositions differ a little: women tend to receive limited examinations, blood pressure checks and drug prescriptions more often; men are more likely to have general examinations, medical counseling or no service at all. Women are retained for follow-up care with the same physician more often; men tend to be sent elsewhere for additional care or no follow-up plans at all are made for them. Sex differences in care are statistically small (only 6% of the many comparisons are significant at P non psychiatrists' offices and it usually shows women receiving more of a given service or disposition. Differential care for women and men can be due to medical factors (such as patient age, prior visit status, seriousness of problem) or psychosocial ones (such as patient requests, patient emotionality, physician sex bias). When we control for several medical factors, the significant sex differences persist. This suggests that the extra care distressed women sometimes receive from nonpsychiatrists is due to patient behavior or physician attitudes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24936/1/0000363.pd

Sex and gender in health and medicine

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22738/1/0000293.pd

Another look at physicians' treatment of men and women with common complaints

A recent study of San Diego patients found that men received more extensive and appropriate diagnostic workups than women did for five common complaints (Armitage, K. J., Schneiderman, L. J., & Bass, R. A. Journal of the American Medical Association 1979, 241 2186–2187). This article is a broader analysis of medical care given to men and women for those complaints (fatigue, headache, vertigo/dizziness, chest pain, back pain), and it uses a national survey of ambulatory-care visits. We find that medical care is usually similar for men and women. When significant sex differences do appear, they often show that women receive more medical care during a visit. To some extent, differential care stems from different medical needs that men and women with a complaint have; when some medically relevant factors are controlled, half of the significant sex differences disappear. But half persist, and this suggests that psychosocial factors also underlie differential care for men and women. These may originate with patients (for example, their requests for particular services) or with physicians (for example stereotypes of men and women patients). In contrast to the San Diego study, the national data show that (1) women sometimes receive more diagnostic workups for the five complaints, and (2) when medical factors are controlled, sex differences in the extent and content of workups disappear . The only exception is that men with vertigo/dizziness receive more appropriate workups.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45571/1/11199_2004_Article_BF00288136.pd

Severity, timing, and structure of disability

Objectives: Severity and timing are key aspects of disability experience for individuals. They also generate a population’s disability structure (prevalence, counts, patterns). We study links among severity, duration, and structure for community-dwelling adults in the US.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43488/1/038_2004_Article_3058.pd

Book reviews

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45647/1/11199_2004_Article_BF00287924.pd