ABSTRACT
Depression is a major growing public health problem. Many population studies have found a significant relationship between depression and the presence of cognitive disorders. Objective: To establish the correlation between the Visual Analogue Scale of Happiness and the Cornell Scale for Depression in Dementia in the population aged 60 years or over in the city of Tremembé, state of São Paulo, Brazil. Methods: An epidemiological survey involving home visits was carried out in the city of Tremembé. The sample was randomly selected by drawing 20% of the population aged 60 years or older from each of the city?s census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, and application of both the Cornell Scale and the Analogue Scale of Happiness for psychiatric symptoms. The presence of depressive symptoms was defined as scores greater than or equal to 8 points on the Cornell Scale. Results: A total of 623 subjects were evaluated and of these 251 (40.3%) had clinically significant depressive symptoms on the Cornell Scale, with a significant association with female gender (p<0.001) and with lower education (p=0.012). One hundred and thirty-six participants (21.8%) chose the unhappiness faces, with a significant association with age (p<0.001), female gender (p=0.020) and low socioeconomic status (p=0.012). Although there was a statistically significant association on the correlation test, the correlation was not high (rho=0.47). Conclusion: The prevalence of depressive symptoms was high in this sample and the Visual Analogue Scale of Happiness and Cornell Scale for Depression in Dementia should not be used as similar alternatives for evaluating the presence of depressive symptoms, at least in populations with low educational level.
A depressão é um problema importante e crescente de saúde pública. É muito comum ser encontrada uma relação significativa entre depressão e a presença de distúrbios cognitivos nos estudos populacionais. Objetivo: Estabelecer a correlação entre a Escala Analógica Visual de Felicidade e a Escala Cornell de Depressão em Demência na população de 60 anos ou mais da cidade de Tremembé, estado de São Paulo, Brasil. Métodos: Estudo epidemiológico no qual foram realizadas visitas domiciliares na cidade de Tremembé. A amostra foi aleatória, através do sorteio de 20% da população acima de 60 anos de cada setor censitário do município. Este estudo foi de fase única, tendo sido realizada anamnese, exames físico eneurológico, avaliação cognitiva e aplicação de escalas Cornell de Depressão em Demência e Escala Analógica de Felicidade para verificar a presença de sintomas depressivos. Foi adotado como critério da presença de sintomas depressivos, pontuação maior ou igual a 8 na escala de Cornell. Resultados: Foram avaliadas 623 pessoas e destas 251 (40,3%) apresentaram sintomas depressivos significativos clinicamente na escala de Cornell, com associação significativa com gênero feminino (p<0,001) e com a baixa escolaridade (p=0,012). Cento e trinta e seis participantes (21,8%) apontaram para faces de infelicidade, com associação significativa com idade (p<0,001), com gênero feminino (p=0,020) e com baixo nível socioeconômico (p=0,012). Embora tenha havido significância estatística no teste de correlação, a correlação entre as duas escalas analisadas não foi alta (rho=0,47). Conclusão: A prevalência de sintomas depressivos foi elevada nesta amostra e a Escala Analógica de Felicidade e a Escala Cornell de Depressão em Demência não devem ser utilizadas como alternativas similares para avaliar a presença de sintomas depressivos, pelo menos em populações com baixa escolaridade.
Subject(s)
Humans , Aged , Prevalence , Cornell Medical Index , Depression , Visual Analog Scale , HappinessABSTRACT
<p><b>OBJECTIVE</b>To observe the effect on intervention of sub-health with pestle needle (Chuzhen).</p><p><b>METHOD</b>Randomized controlled trail was adopted for this research. One hundred and fifty-three cases were randomly divided into two groups of a Chuzhen group (79 cases) and a massage group (74 cases). Acupoint of Bazhen (Baihui Bazhen, Shendao Bazhen, Zhiyang Bazhen, Mingmen Bazhen, Yaoyangguan Bazhen), Hechelu on the head, the neck and the lumbar area were adopted in Chuzhen group. While regular whole-body massage was applied in the massage group. The human sub-health score, the cornell medical index (CMI) and thermal texture maps system (TTM) technology of the two groups before and after the intervention were observed.</p><p><b>RESULTS</b>1) After treatment, sub-health condition score, the CMI score, the M-R score and the TTM index were all increased in both groups (all P<0.01) 2) Comparison of D-value of the two groups before and after the intervention: the level of the sub-health score, the total score of CMI, and the index of sleep, pressure, Governor Vessel, Hukou (first web), blood lipid, viscosity of blood, microcirculation of TTM index of the Chuzhen group changed more obvious (all P<0.01), but there was no statistic significances in the M-R score and blood sugar of the TTM (both P>0.05). 3) The sub-health condition score in Chuzhen group was higher than that in the massage group (P<0.01).</p><p><b>CONCLUSION</b>Chuzhen therapy has definite effect on intervention of sub-health, which is better than regular general massage.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acupuncture Points , Acupuncture Therapy , Cornell Medical Index , MassageABSTRACT
El aprovechamiento de la información proporcionada por un grupo de variables clínicas esenciales de obtención inmediata permite aumentar sensiblemente la exactitud del ECG para la determinación de la masa ventricular izquierda
Subject(s)
Humans , Body Mass Index , Cornell Medical Index , Electrocardiography , Hypertrophy, Left Ventricular , Lown-Ganong-Levine Syndrome , Ventricular Function, LeftABSTRACT
OBJETIVO: El presente estudio se propone describir las principales alteraciones del sueño en la población de ancianos mayores de 65 años en Viña del Mar y la búsqueda de correlación estadística frente a la existencia de disturbios emocionales PERSONAS Y METODO: Se utilizó una encuesta que incluye un test de sueño elaborado por los autores y la escala de Cornell que mide disturbios emocionales, la cual se aplicó a adultos mayores de 65 años de la comuna de Viña del Mar durante el mes de agosto de 2002 RESULTADOS: La muestra correspondió a 57 adultos mayores y se mencionan los detalles descriptivos más sobresalientes de distintas alteraciones del sueño. Con respecto a pérdida de la normalidad del sueño nocturno, un 47,3 por ciento, 28 por ciento y 26,3 por ciento de los encuestados manifestaron (regularmente o siempre) episodios múltiples de despertar nocturno, insomnio de conciliación e insomnio de despertar precoz, respectivamente. Con relación a conductas anormales durante el sueño sobresale el ronquido (60 por ciento regularmente o siempre) y somnolencia diurna (21 por ciento co el hábito de la siesta). Se agrega descripción de horarios de sueño y sobreconsumo de fármacos y alcohol. Del análisis de los resultados se obtiene una correlación estadística entre alteración de sueño y disturbios emocionales (P<0,0001), así como entre la intensidad de las alteraciones emocionales y la magnitud de las alteraciones del sueño (correlación de Pearson= 0,63)DISCUSION: Se discuten las implicancias de los hallazgos y la importancia de la evaluación del sueño en pacientes adultos mayores.
Subject(s)
Humans , Aged , Geriatric Assessment/statistics & numerical data , Sleep Wake Disorders/diagnosis , Affective Symptoms , Chile , Cornell Medical Index , Sleep Stages , SnoringABSTRACT
The purpose of study was to find out the relationship between health perception and health status of clinical nurses. It also identified factors that related to health perception and health status of clinical nurses. The research design was descriptive correlational study. The subjects were. consisted of 289 clinical nurses at the university hospital in Pusan, The data were collected from Feb. 12th to Feb, 28th, 2001 by self reporting structured questionnaires. The instruments used for this study were health perception questionnaire developed by Ware and Cornell Medical Index modified by Nam Ho-Chang (1965) for measuring health status. The data were analyzed by SPSS/PC+ program using frequency, percentage, mean, mean mark, standard deviation, t-test, ANOVA, Scheffe test, and Pearson's correlation coefficient. The results of this study were as follows. 1. The mean score of the health perception was 94,70+/-.93(range 29-145), which the item mean mark score was 3.27+/-.31(range 1-5). The score of subarea of the health perception was the highest score in health concern (4.57+/-.58) and the lowest sore in rejection of sick roie(2.94+/-.32). 2. The mean score of the health status was 102.83+/-.61(range:57-114), which the item mean mark score was 1.80+/-.13(range:1-2). The mean mark score of the physical health status was 62.55+/-.35(l.69+/-.14) and the mental health status was 40.28+/-.51 (1.83+/-.16). 3. There were statistically significant difference in the score of health perception according to the presence of disease(F=4.607, p=.011), job satisfaction (F=12.242, p=000), and job place(F=2.838, P= .038) 4. There were statistically significant difference in the score of health status according to the age(F=3.164, p= .007), presence of leisure time(F=4.308, P=039), presence of diseases (F=3.215, P= .042), job experience (F=9.064, P= .000), job satisfaction (F= 7.182, P= .001), job place (F=5.638, P=.001), job position (F=3.900, P= .021). 5. Health perception of clinical nurse was shown to be positively related to health status(r= .543, p= .000) In conclusion, health perception of clinical nurse working at the university hospital was relatively high, and health status was fine. And the more health perception was high, the more health status was high. Therefore, the health promotion program for clinical nurses, should included health perception.
Subject(s)
Analysis of Variance , Cornell Medical Index , Health Promotion , Job Satisfaction , Leisure Activities , Mental Health , Surveys and Questionnaires , Research Design , Self ReportABSTRACT
The purpose of this study is to compare the physical health, anxiety and depression of the Dan-Jeon Breathing trained group with those of a non-trained group and to analyze the relationship between the training period of Dan-Jeon Bre athing method and physical health, anxiety, and depression. The number of people in the Dan-Jeon Breathing trained group over 3 months was 149 and in the non-trained group 142. Data were collected from August to October 1999. As tools, 35 physical symptom questions were chosen from The Cornell Medical Index modified by Nam(1965) and from the Symptom Checklist-90-Revision(SCL-90-R) by Kim(1984); 10 questions on anxiety and 13 questions on depression were used in the study. The statistics of the study were gathered by using SPSS Window; the analysis was made by applying x(2)-test, t-test, Pearson correlation, ANOVA and Scheffe tests. The results were as follows. 1. The Dan-Jeon Breathing trained group had lower physical symptom score and showed less anxiety and depression than the non-trained group, which supported the 1st, 2nd, 3rd hypotheses. 2. The longer the training period of Dan-Jeon Breathing, the lower the physical symptom score, which supports the 4th hypothesis, but the 5th and, 6th hypotheses were not supported because anxiety and depression did not get lower as the training period of Dan-Jeon Breathing got longer. 3. The physical symptom score, anxiety and depression that were made by the general characteristics of Dan-Jeon Breathing trained group were analyzed. As a result, the physical symptom score of women was greater than that of men. Physical symptoms score and the rate of anxiety and depression were different by education levels. The degree of anxiety was different by age. Those who have a religion have a higher physical symtoms score than people who have no religion. There was no difference in physical health score, anxiety and depression according to marital status, economic status and occupations. The results suggest that the physical and mental health status of Dan-Jeon Breathing trained group is better than that of the non-trained group. Physical symptoms scores gets lower as the training period of Dan-Jeon Breathing gets longer which results in the improvement of physical health status.
Subject(s)
Female , Humans , Male , Anxiety , Cornell Medical Index , Depression , Education , Marital Status , Mental Health , Occupations , RespirationABSTRACT
O autor aplicou o questionário padronizado Cornell Index em pacientes dependentes de álcool (n = 37) e pacientes dependentes de cocaína ou crack (n = 52), abstinentes em tratamento no Instituto Bairral de Psiquiatria de Itapira, Säo Paulo, Brasil. O objetivo da pesquisa foi identificar nas amostras a presença de sintomas psicossomáticas e de comportamento. Os questionário foram avaliados com base no Método C do Cornell Index. Também os escores foram analisados e discutidos por agrupamentos dos sintomas ou problemas
Subject(s)
Humans , Alcohol-Related Disorders , Cocaine-Related Disorders , Cornell Medical Index , Crack Cocaine , Psychophysiologic Disorders/chemically induced , Affective Disorders, Psychotic/chemically inducedABSTRACT
Trata-se de um estudo para avaliar as relaçöes de amizade em meninos de rua de 7 a 11 anos da cidade de Porto Alegre, RS, Brasil. Uma amostra de 30 meninos de rua foi comparada com outra de 51 meninos de 7 a 11 anos que viviam com suas famílias de baixa renda, utilizando-se a Entrevista Sobre Amigos e Companheiros da Cornell (Cornell Interview of Peers and Friends). Os dois grupos apresentaram escores globais na entrevista significativamente diferentes, sendo que o grupo de meninos de rua obteve o escore médio mais alto. Da mesma forma, os meninos de rua apresentaram escores de adequaçäo do desenvolvimento, autoestima e habilidades sociais significativamente menores do que os meninos com família. Levando-se em conta os resultados, é enfatizada a urgência do desenvolvimento de intervençöes com as crianças com vivência de rua, especialmente com os meninos de rua
Subject(s)
Child , Humans , Male , Female , Family , Homeless Youth/psychology , Interpersonal Relations , Poverty , Child Behavior , Cornell Medical Index , Health Promotion , Psychology, ChildABSTRACT
Se ha estudiado una población urbana de la ciudad de Lima asentada en un área de tipo ôslumõ. Sus pobladores estaban integrados, en su mayoría, por personas procedentes de provincias, en particular de la Sierra, principalmente obreros no calificados, distribuidos en diferentes grupos domésticos. Se les aplicó el Indice Médico de Cornell en una fase preliminar de una investigación de morbilidad psiquiátrica. Los resultados obtenidos han revelado incidencia elevadísima de ansiedad, síntomas depresivos, tendencias hipocondriacas, inadecuación y agresividad en la muestra explorada. Se analizan los resultados apreciándose diferencias en función del sexo, edad, composición familiar y fenómenos migratorios. Se señalan posibles factores sociales y culturales en el condicionamiento de la patología emocional encontrada. Este estudio ha comprobado, una vez más, la valides del I. M. C. como instrumento de exploración preliminar o screening para la identificación de los casos con desórdenes emocionales significativos.
Subject(s)
Morbidity , Psychiatry , Urban Area , Cornell Medical Index , PeruABSTRACT
The result of the close analysis of the health status of 549 working students (the experimental group) of a high school attached to an industry and that of 1,259 non-working students (control group) based on the question provided by CMI from 1st, June to 31st, July 1984 has been revealed as follows: 1. In contrast with the control group, the experimental one is statistically noticeably higher (p<0.01) in their average complaints both in terms of the whole items(A-R) and the physical items(A-L). 2. In the experimental group, particularly the item(L) for habits has the highest rate of average complaints, followed by the item(B) for the respiratory system and the item(E) for the musculoskeletal system. 3. The average complaints of the individual class in both the experimental group and the control group have the tendency to be on the increase accordingly as the school year goes up, and the increasing rate of the experimental group has turned out to be higher than that of the control group. 4. The average complaints of the experimental group based on residential types are the highest(34.7%) in the case of cooking food for oneself, followed by a dormitory(30.3%), and one's own house(28.5%). 5. The average complaints based on the individual working place has been found out to be higher than the rest in the item of the miscellaneous disease of the blowing and roving parts, the respiratory system of the carding part, the fatigability of the spinning part, the tension of inspecting part.
Subject(s)
Humans , Cooking , Cornell Medical Index , Musculoskeletal System , Respiratory SystemABSTRACT
This paper was carried out for comparison of respiratory symptoms between urban and rural residents that is somewhat related to air pollution. And as urban residents, 470 persons of Daegu (Taegu) and 364 of Pohang were selected and 472 rural residents were also, in Eus ng-Gun, those who were responded to questionnaire distributed from April 10, 1984 to April 30 through students of middle or high school. The subjects were families of the student. The questionnaire was appropriately modified the item B of Cornell Medical Index by author. Looking into the rate of complaints about each part, generally, the rate in urban is higher than that in rural. Particularly it is higher to 'feeling a choking lump or swelling of throat', 'the sputum' and 'the asthma' in the city (p<0.05). On the contrary, women in the farm village, to 'caught a severe cold' as compared with the city. In men under nineteen years of age, it is higher than the farm village to 'feeling a choking lump or swelling of throat' of Pohang (p<0.05). But in men forties, it is higher than the city that farm people are 'soaking sweat at night' and 'foreign body sensation on throat'. Students hardly differ between the two ares, while the group having occupation in Pohang felt more in 'feeling a choking lump or swelling of throat' than the farm residents. As the result, I consider that the rural residents were much affected by physical fatigue and pesticides, and the urban, by some problems of industrial fuel, traffic gas and various dusts.
Subject(s)
Female , Humans , Male , Air Pollution , Airway Obstruction , Cornell Medical Index , Dust , Fatigue , Occupations , Pesticides , Surveys and Questionnaires , Sensation , SweatABSTRACT
Melasma is characterized by chronic dark brown pigmentation on the face which is known to be little effective by remedies. It is still unkown the exact cause of the diaease, but pregnancy, oral contraceptives, sun-light, csometics, endocrinologic disturbances and malnutrition could be speculated as causative factors. According to our clinical experiences, some of the melasma patients were related with psychic and physical problems. The disease state of 400 cases with melasma was categorixed by our own designed questionaire, based on the dinical condition and history. 86 of 400 casea were analysed by Cornell Medical Index to elucidate the psycholagical and physiological problems
Subject(s)
Humans , Pregnancy , Contraceptives, Oral , Cornell Medical Index , Malnutrition , Melanosis , PigmentationABSTRACT
By evaluating the health status of 152 male workers engaged in a metal-product factory by Cornell Medical Index in conjunction with their experience of industrial accident, I attempted to find out whether any health condition may effect on the occurrence of industrial accident. Differences in frequency of complaints in each section of CMI between control workers and accident workers were statistically tested by T-test. On the other hand, influence of neuropsychiatric factors (section M-R) on the occurrence of accidents was analyzed by X(2)-test with Fukamachi's classification. The followings were the results obtained in this study. 1. The average number (26.42) of physical complaints in accident group is significantly more than in control group (18.70). 2. The average number (17.70) of mental complaints in accident group is very significantly more than in control group (11.70). 3. Differences in frequencies of complaints by sections between accident group and control group was all significant except C(cardiovascular system), H(genitourinary system), I (fatigue) & J (frequency of disease). 4. Frequency rate of neurotic workers who were identified by Fukamachi's classification was significantly higher in accident group (72%) than in control group (51%).
Subject(s)
Humans , Male , Accidents, Occupational , Classification , Cornell Medical Index , HandABSTRACT
The cornell medical index is self-administered instrument that collects a large body of significant medical and psychiatric data. The original C. M. I. consists of 195 questions, but authors selected 60 questions from the original C. M. I. to simplify it. The purpose of this investigation is to clarify if there are any correlations between low back pain and extraskeletal disorders. This investigation was conducted on 144 in-and out-patients who were treated at the Department of Orthopaedic Surgery,Our Lady of Mercy Hospital, Catholic Medical College from Jan. to July 1977. Among them 75 patients were male,69 patients were female, and 22 patients had decompression laminectomy and discectomy. The results of this investigation are as follows; 1. The majority of patients with low back pain are 2nd to 4th decade. (Male: 30±10.7) (Femal:36.1±10.5) 2. Average number of complaints is 19.9/60 in male, 21.8/60 in female. 3. Complaints in section F(Fatigability) and G(mental) are predominant in all cases. 4. There are no significant difference in number of complaints between the operative and non-operative case, and between each decade.
Subject(s)
Female , Humans , Male , Cornell Medical Index , Decompression , Diskectomy , Laminectomy , Low Back Pain , OutpatientsABSTRACT
By evaluating the health status by Cornell Medical Index in conjunction with their academic grade, we attempted to find out whether any health condition may affect on their academic carrier. CMI health questionnaire was filled out by student and matched with one's own academic score of the previous year. Academic score was classified into 5 grades: excellent, very good, good, fair and poor. Difference in number of questions between sections was corrected by standard score method with means of 50 and standard deviation of 10. Differences in number of "yes" answers between sections and between groups of students in each grade were statistically tested by two-way variance analysis method. On the other hand, influence of neuropsychiatric factors (section M-R) on the academic carrier was analyzed by X2-test with Fukamachi's classification. The following were the results obtained in this study : 1) Number of "yes" answers in sections related to mood and feeling pattern(section M-R) were appeared to be influential to academic carrier in male students, but not in female students. 2) Generally speaking, in groups of higher academic grade, number of "yes" answers in each section was on an average 50 or less, and in groups of lower academic grade, the number was 50 or more depending on sections. 3)Number of "yes" answers between sections and between groups in each academic grade were significantly different both in male and female college students. 4) It was noteworthy that data obtained from CMI questionnaire might be variable subjective by examines with some factors at the time of administration.
Subject(s)
Female , Humans , Male , Classification , Cornell Medical Index , Hand , Surveys and QuestionnairesABSTRACT
This st;udy was to obtain psychosomatic factors influencing cause of chronic ureicaria and alopecia areata with comparison of dermatophytosis. This survey was carried out by Cornell Medical Index from March 1975 to- September 1976 on total 93 persons which constitute 22 chronic urticaria,38 alopecia areata and 33 dermatophytosis at; the out patient clinic of dermatology department of St. Mary hospital Findings were as follow: 1. The average numbr of complaints of over-all section was 47.36+26.89, the somatic section (31. 73+16. l4) and the psychic (l5. 64+-12. 64) in the chranic urticaria. The average number of complaints of over-all section was R8.50+20.89, the somatic section (22. 63+-13. 10) and psychic section (15. 87+-9. 90) in the alopecia areata, For the control, over-all section was 25. 18+18. 87, the somatic section (16. 30+l2. 38) and the psychic(8. 88+8. 96) in the dermatophytosis. Consquently, there was an increased number of complaints in the group of chronic urticaria and alopecia areata than the control group. 2. There was increased complaint of both the somatic and psychic section in the chronic urticaria. 3. There was increased complaint of psychic section than the somatic section in the alopecia areata.
Subject(s)
Humans , Alopecia Areata , Alopecia , Cornell Medical Index , Dermatology , Tinea , UrticariaABSTRACT
From May lst to November 30th, 1971, a study was conducted by authors on the health status of industrial workers through applying the modified Cornell Medical Index forwards a total of 4,565 labourers working in Busan City. The obtained results were as follows : 1. The largest number of industries and labourers was in Busanjin Gu, 9 and 2,386 (52.2%), respectively. 2. Total numbers of labourers subjected to the survey were 2,355 (51.6% in male, 2,210(48.4%) in female. 3. By age and sex distribution, the largest was seen with the age group of 25-34, 1,260 in male, otherwise with under the age group of 24, 1,994 in female labourers. 4. The highest average number of complaints by section among all age groups and industries was as follows ; In case of male labourers, textile was the highest with numbering 8.7 (35-39 age group) in the section of physical complaints, in the section of mental and total complaints, food industry was the highest with numbering 8.2 and 16.4, respectively, both under 19 age group, otherwise in case of female labourers, food industry was the highest with numbering 12.3 (physical), 10.3(mental) and 22.7 (total complaints) with all in 20-24 age group. 5. The lowest average number of complaints by section among all age groups and industries was as follows; In case of male labourers, other industry was the lowest with numbering 0.4 (55and over) in the physical, 0.3 (19and under) in the mental and 0.7 (55and over) in the section of total complaints, otherwise incase of female labourers, basic metal was the lowest in the all sections with all in 50-54 age groups.
Subject(s)
Female , Humans , Male , Cornell Medical Index , Food Industry , Sex Distribution , TextilesABSTRACT
From May lst to November 30th, 1971, a study was conducted by authors on the health status of industrial workers through applying the modified Cornell Medical Index forwards a total of 4,565 labourers working in Busan City. The obtained results were as follows : 1. The largest number of industries and labourers was in Busanjin Gu, 9 and 2,386 (52.2%), respectively. 2. Total numbers of labourers subjected to the survey were 2,355 (51.6% in male, 2,210(48.4%) in female. 3. By age and sex distribution, the largest was seen with the age group of 25-34, 1,260 in male, otherwise with under the age group of 24, 1,994 in female labourers. 4. The highest average number of complaints by section among all age groups and industries was as follows ; In case of male labourers, textile was the highest with numbering 8.7 (35-39 age group) in the section of physical complaints, in the section of mental and total complaints, food industry was the highest with numbering 8.2 and 16.4, respectively, both under 19 age group, otherwise in case of female labourers, food industry was the highest with numbering 12.3 (physical), 10.3(mental) and 22.7 (total complaints) with all in 20-24 age group. 5. The lowest average number of complaints by section among all age groups and industries was as follows; In case of male labourers, other industry was the lowest with numbering 0.4 (55and over) in the physical, 0.3 (19and under) in the mental and 0.7 (55and over) in the section of total complaints, otherwise incase of female labourers, basic metal was the lowest in the all sections with all in 50-54 age groups.