Search PubMed⌕ Search

Biomedical subjects

F D Wolinsky

Publications and source records attributed to F D Wolinsky.

At least 73 records · Page 4Linked to original sources
PubMed1993

Nutritional risk and survival in elderly veterans: a five-year follow-up.

The purpose of this study was to identify predictors of survival over five years in a sample of 377 elderly (age 55+) chronically ill men. Subjects were selected at baseline from consecutive appointments at a geriatric clinic and given extensive medical and psychosocial assessment. Five years later, subjects who could be located were interviewed by telephone. Interviews were completed with 194 (51.4%) subjects, 90 others were confirmed as deceased, 29 subjects could not be interviewed, and 64 more were not located although VA records did not show that any were deceased. The predictor variable of interest was the Nutritional Risk Index (NRI), a 16 item index which measures nutritional dimensions of health status. Other variables included functional health status [Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL)], mental health status [Mini-Mental Status Exam (MMSE), morale], health habits (smoking, alcohol use and exercise), use of health services (physician visits, emergency room (ER) visits, hospital stays), and demographic factors (age, income, marital status and living arrangements). Proportional hazard models showed that the variables with statistically significant direct effects on survival time were younger age, higher functional health status on IADL, non-smoking, moderate alcohol use, and perception of adequate income. Nutritional status was indirectly associated with survival.

Activities of Daily Living↗
PubMed1993

Replication of the multidimensionality of activities of daily living.

We attempted to replicate the three-dimensional factor structure of a previously proposed ADL scale and demonstrate an association between the advanced ADL dimension and cognitive function. Data used in these analyses were baseline assessments of health and functional status of hospitalized patients enrolled in a randomized controlled trial of case managers as a means of reducing health care utilization. We submitted 14 items from the OARS to a two-stage process of principal components factor analysis. Four significant dimensions emerged that were remarkably similar to the advanced, basic, and household ADL dimensions reported by Wolinsky and Johnson (1991). In this sample of hospitalized patients, however, incontinence emerged as a weak fourth dimension. Multiple regression of SPMSQ mental status examination scores on these ADL dimensions demonstrates the association between cognitive function and the advanced ADL dimension. These data confirm that the underlying structure of ADLs consists of at least three separate dimensions, one of which is aligned with cognitive capacity.

Activities of Daily Living↗
PubMed1993

The moral development of medical students: a pilot study of the possible influence of medical education.

Medicine endorses a code of ethics and encourages a high moral character among doctors. This study examines the influence of medical education on the moral reasoning and development of medical students. Kohlberg's Moral Judgment Interview was given to a sample of 20 medical students (41.7% of students in that class). The students were tested at the beginning and at the end of their medical course to determine whether their moral reasoning scores had increased to the same extent as other people who extend their formal education. It was found that normally expected increases in moral reasoning scores did not occur over the 4 years of medical education for these students, suggesting that their educational experience somehow inhibited their moral reasoning ability rather than facilitating it. With a range of moral reasoning scores between 315 and 482, the finding of a mean increase from first year to fourth year of 18.5 points was not statistically significant at the P < or = 0.05 level. Statistical analysis revealed no significant correlations at the P < or = 0.05 level between the moral reasoning scores and age, gender, Medical College Admission Test scores, or grade point average scores. Along with a brief description of Kohlberg's cognitive moral development theory, some interpretations and explanations are given for the findings of the study.

Adult↗
PubMed1993

The structure of health status among older adults: disease, disability, functional limitation, and perceived health.

This article builds on earlier conceptualizations of the structure of health status to propose a more complex, multiequation model that examines the interrelationships among its various dimensions. As such, the focus is not merely on the identification of the direct effects of a variety of factors on perceived health status, but on how the constructs of disease, functional limitation, and self-rated health interrelate. In so doing, we expose the inherent problems of several complex and contaminated items routinely included in applications of established functional health status measures. The source of these problems lies in the lack of specificity or conceptual clarity for the individual items in these established measures. Potential biases are discussed, and several methods and strategies for addressing these problems are explored. Alternative scales are constructed and their psychometric properties are presented. Researchers who rely on public use data bases containing these scales should be aware of the potential biases and either modify the scales or use other appropriate methodologies to control for the measurement contamination.

Activities of Daily Living↗
PubMed1993

Changes in functional status and the risks of subsequent nursing home placement and death.

This research examined the effects of changes in functional status on the risks for subsequent nursing home placement and death. Using data on the 3,646 baseline self-respondents to the Longitudinal Study on Aging who were successfully reinterviewed at the first follow-up (1986) and who were not in a nursing home at that time, a two-stage analysis was conducted. First, the risks for nursing home placement and death between the 1986 and 1988 follow-ups were modeled based on a static set of baseline (1984) indicators. Measures of the change in functional health status between baseline and first follow-up were then introduced to determine whether such change had significant net effects and enhanced model fit. Substantial improvement in model fit was obtained for both outcomes. The risk of nursing home placement was associated with deterioration in advanced (i.e., cognitive) ADLs and lower body function. Deterioration in basic ADLs and lower body function was associated with the risk of dying.

Activities of Daily Living↗
PubMed1992

Widowhood, health status, and the use of health services by older adults: a cross-sectional and prospective approach.

Using data from the LSOA, we examined the relationship between widowhood, health status, and the use of health services. Controlling for the characteristics specified in the behavioral model, a cross-sectional assessment of the 2,354 respondents widowed at baseline showed that regardless of how the recency of widowhood is modeled, it is not related to any measure of health status, and it is only marginally associated with two measures of health services utilization: nursing home placement and death. A prospective assessment of the 4,113 respondents reinterviewed at follow-up produced similar results. Becoming widowed did not alter previous reports of health status, nor prior patterns of physician or hospital utilization. Being widowed did, however, significantly increase the likelihood of being placed in a nursing home. For the 14 respondents who were both widowed and placed in a nursing home after baseline, the sequence is always widowhood first, and then nursing home placement.

Aged↗
PubMed1992

The risk of nursing home placement and subsequent death among older adults.

This article examines the effects of the characteristics specified in the behavioral model of health services utilization and measured at baseline on the subsequent risk of nursing home placement and death within four years. Analyses of the 5,151 respondents in the Longitudinal Study on Aging indicate that the risk for nursing home placement is greater for older adults, Whites, those who lived alone, persons with telephones, those with fewer nonkin social supports, those who did not feel that they had much control over their future health, those with more household ADL or lower body limitations, and those who had been in the hospital during the year prior to baseline, or in a nursing home at any time before baseline. Among the 549 respondents placed in nursing homes, the risk of dying there was greater for older adults, men, those who had not lived in multigenerational households, persons who did not worry about their health, individuals with more upper body limitations, and respondents having a history of valvular heart disease or cancer. The odds of dying were 2.74 times greater among the 549 respondents placed in nursing homes than among the 4,602 respondents who remained in the community.

Aged↗
PubMed1992

Perceived health status and mortality among older men and women.

This article separately examines the relationship of perceived health status and mortality for the 1,599 men and 2,904 women self-respondents in the Longitudinal Study on Aging. Using hierarchical logistic regression, the zero-order relationships are decomposed by the serial introduction of demographic, socioeconomic, health status, and psychosocial factors. For men, only those in poor health are significantly more likely to die than those in excellent health (adjusted odds ratio = 1.754), all other things being equal. For women, those in fair or poor health are more likely to die than those in excellent health (adjusted odds ratios = 1.870 and 2.181, respectively), all other things being equal.

Aged↗
PubMed1992

Falling, health status, and the use of health services by older adults. A prospective study.

In this study, data from the Longitudinal Study on Aging were used to prospectively assess the relationship between repetitive falling or falling only once in the year before baseline and changes in health status and the use of health services. Multiple and logistic regression were used to control for a variety of known covariates, in addition to the baseline values of the target outcomes. Repetitive falling was associated with decreased health status, measured by various activities of daily living and disability indices, at both 2- and 4-year follow-ups. One fall, however, was never associated with deteriorating health status. Similarly, repetitive falling was related to a decreased likelihood of visiting a physician (at the first follow-up, only), but to an increased likelihood of hospitalization, nursing home placement, and death (at both follow-ups). Falling just one time, however, was only associated with an increased likelihood of nursing home placement. Based on outcome trajectories, two subpopulations of repetitive fallers were identified. One subpopulation was consistent with the rapid deterioration hypothesized by the "spiral" response to falling, and includes about 35% of the repetitive fallers (i.e., those who die within 4 years of baseline). The other subpopulation was consistent with the initial decline and subsequent stabilization hypothesized by the "drop-stabilization" response.

Accidental Falls↗
PubMed1992

Evaluation of teaching medical ethics by an assessment of moral reasoning.

This study assessed the hypothesis that the formal teaching of medical ethics promotes a significant increase in the growth and development of moral reasoning in medical students. Results indicated a statistically significant increase (P less than or equal to 0.0005) in the level of moral reasoning of students exposed to a medical ethics course compared to the control group that was not exposed to the medical ethics course. When the posttest scores were adjusted by subtracting the pretest scores, the differences were even more significant (P less than or equal to 0.0002). This study confirmed similar findings of another study using a different instrument of assessment. Brief discussion is given of the fundamental premise that the appropriate function of teaching medical ethics in our modern pluralistic society is to improve students' moral reasoning about value issues regardless of what their particular set of moral values happens to be.

Education, Medical, Undergraduate↗
PubMed1991

Study of the influence of veterinary medical education on the moral development of veterinary students.

Although veterinary medicine endorses high moral character and adherence to a code of ethics, to our knowledge, virtually no studies have examined the influence of veterinary medical education on the moral development of its students. Using the Kohlberg standard moral judgment interview, this study examined that relationship in a sample of 20 veterinary medical students (16.0% of the veterinary college's student body). The students were tested at the beginning and at the end of their veterinary medical education to determine whether their moral reasoning scores had increased to the same extent as those of other postgraduate students. It was found that normally expected increases in moral reasoning did not occur over the four years of veterinary medical education for these students, suggesting that their veterinary medical educational experience somehow inhibited their moral reasoning ability rather than facilitated it. With a range of moral reasoning scores between 313 and 436, the mean increase from first year to fourth year of 12.5 points was not statistically significant. Statistical analysis revealed no significant correlations between the moral reasoning scores on age or gender, although there were significant correlations with Medical College Admissions Test scores and grade point average scores.

Education, Veterinary↗
PubMed1991

The use of health services by older adults.

Using baseline data on the 5,151 respondents surveyed as part of the panel design of the Longitudinal Study on Aging (LSOA), this article estimates, cross-sectionally, the relationships hypothesized in the behavioral model of health services utilization. In addition to the traditional indicators of the predisposing, enabling, and need characteristics, the richness of the LSOA permits the inclusion of measures of multigenerational living arrangements, kin and nonkin social supports, health worries and the sense of health control, health insurance coverage, residential stability, and several multiple-item scales of functional limitations. Despite these innovations, the ability of the behavioral model to accurately predict the use of health services by older adults remains relatively unchanged. Important conceptual clarifications involving the hypothesized relationships, however, are identified and discussed.

Activities of Daily Living↗
PubMed1990

Correlates of a measure of coping in older veterans: a preliminary report.

Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N = 240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.

Activities of Daily Living↗
PubMed1990

Progress in the development of a nutritional risk index.

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Aged↗
PubMed1990

A comparison of in-house and regionalized computerized tomography scanning: clinical impact and cost.

Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were obtained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part of the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that VA hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

Aged↗
PubMed1990

The legacy of stress research. The course and the impact of this journal.

The Journal of Health and Social Behavior (JHSB) is examined to determine its relative stature and impact in the social science community. We conducted both empirical comparisons of average impact (based on the Social Science Citation Index) and content analysis. Over an 11-year period beginning in 1977, JHSB has maintained an enviable position among sociology journals, ranking significantly higher than the American Journal of Sociology and Social Forces. In addition, it ranks quite favorably when compared with the dominant journals of the allied social science disciplines. The preeminence of the JHSB is attributed to the legacy of stress research that was perceived to dominate this period. Ironically, the recently mandated change in editorial goals eschewing such an identification with stress research has begun to undermine the overall stature of the journal, primarily by reducing the impact of articles on stress that appear in it. We discuss the mechanisms that have influenced the course and the impact of this journal.

Evaluation Studies as Topic↗