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H Morgenstern

Publications and source records attributed to H Morgenstern.

At least 19 recordsLinked to original sources
PubMed1992

Inappropriate medication prescribing in skilled-nursing facilities.

OBJECTIVE: To quantify the appropriateness of medication prescriptions in nursing home residents. DESIGN: Prospective, cohort study. SETTING: Twelve nursing homes in the greater Los Angeles area. PARTICIPANTS: A total of 1106 nursing home residents. MAIN OUTCOME MEASURES: The appropriateness of medication prescriptions was evaluated using explicit criteria developed through consensus by 13 experts from the United States and Canada. These experts identified 19 drugs that should generally be avoided and 11 doses, frequencies, or durations of use of specific drugs that generally should not be exceeded. RESULTS: Based on the consensus criteria, 40% of residents received at least one inappropriate medication order, and 10% received two or more inappropriate medication orders concurrently; 7% of all prescriptions were inappropriate. Physicians prescribed a greater number of inappropriate medications for female residents. Regression analysis, corrected for clustering effects within facilities, showed that a greater number of inappropriate medication prescriptions were ordered in larger nursing homes. Inappropriate prescriptions were not related to the proportion of Medicaid (Medi-Cal) residents or the number of physicians practicing in the homes. CONCLUSIONS: Inappropriate medication prescribing in nursing homes is common. Female residents and residents of large nursing homes are at the greatest risk for receiving an inappropriate prescription.

Aged↗
PubMed1992

Multidimensional risk assessment versus age as criterion for retirement of airline pilots.

OBJECTIVE: To determine whether airline pilots over the age of 60 pose a hazard to aviation safety and whether risk assessment could replace age-based retirement. DATA SOURCES: A computer-assisted literature search (MEDLINE), expert consultation, and government reports. STUDY SELECTION: Original studies on flight performance and pilot age; sudden incapacitation, neuropsychological testing, and/or medication use in pilots; and/or non-invasive testing for predicting sudden death or stroke in asymptomatic subjects. DATA EXTRACTION: Pertinent results and methods data were abstracted from the 49 included studies. DATA SYNTHESIS: No study on aircraft accidents or pilot performance has shown an increased accident risk for over-60-year-old pilots. Normal age-related cognitive changes probably have minimal impact on aviation safety up to age 70, given above average health, education, and experience in airline pilots. Cognitive tests have not been validated for predicting flight performance safety, but they can detect early stages of cognitive disease. Cardiovascular incapacitation risk increases with age, but risk factor profiles and non-invasive tests could identify pilots with non-acceptable risk. CONCLUSIONS: An improved medical certification test could identify those pathologic conditions that might occur more frequently in older subjects. If pilots also underwent adequate performance testing, a gradual increase of the retirement age to approximately age 70 would seem justified. In the future, a longitudinal database should be established to validate medical tests for their ability to predict a pilot's accident risk. Using individual pilots as their own controls might be more sensitive than using population-based norm values. Progress in this field would advance medical assessment for other groups such as air traffic controllers or automobile drivers.

Accidents, Aviation↗
PubMed1992

Impact of occupations and job tasks on the prevalence of carpal tunnel syndrome.

In this investigation reported epidemiologic studies on carpal tunnel syndrome (CTS) (15 cross-sectional studies involving 32 occupational or exposure groups and six case-referent studies) were reviewed. The prevalence of CTS in the different occupational groups varied between 0.6 and 61%. The highest prevalence was noted for grinders, butchers, grocery store workers, frozen food factory workers, platers, and workers with high-force, high-repetitive manual movements. Odds ratios greater than 10 were reported for exposed groups in three studies. On the basis of epidemiologic and other evidence, it was concluded that exposure to physical work load factors, such as repetitive and forceful gripping, is probably a major risk factor for CTS in several types of worker populations. At least 50%, and as much as 90%, of all of the CTS cases in these exposed populations appeared to be attributable to physical work load.

Adult↗
PubMed1992

Choosing quality of care measures based on the expected impact of improved care on health.

Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health.

Breast Neoplasms↗
PubMed1991

A cross-sectional study of hand/wrist symptoms in female grocery checkers.

A questionnaire was mailed, in 1986, to 1,345 grocery checkers who belonged to one union local in south-central California. Among the 1,058 female respondents (82% response rate), we found a 12% prevalence of hand/wrist symptoms characteristic of carpal tunnel syndrome (CTS). Symptom prevalence was positively associated with age, average work hours per week, years worked as a checker, and use of diuretics. The estimated effect of years worked as a checker was greater for younger subjects than for older subjects, in whom the association reversed, suggesting the selective loss of symptomatic workers from their jobs (a form of the healthy-worker effect). Although no effects were found for specific job-related activities, we estimate that CTS symptoms in at least three of every five symptomatic workers were attributable to occupational exposures.

Adolescent↗
PubMed1991

The prediction of chronic persistent versus intermittent tardive dyskinesia. A retrospective follow-up study.

Relatively little is known about the course of TD in patients continuing to receive neuroleptic medication. In a retrospective follow-up study of 192 patients seen two or more times (average 7.7 visits) over 3-55 months in the Yale Tardive Dyskinesia Clinic, 112 (58%) demonstrated a 'chronic persistent' pattern, the remainder an 'intermittent' pattern. The most important predictors of chronic persistent TD, using multiple logistic-regression analyses, included increased age and the presence of non-orofacial TD at baseline.

Antipsychotic Agents↗
PubMed1991

Comparing the predictive accuracy of health risk appraisal: the Centers for Disease Control versus Carter Center program.

BACKGROUND: From 1986 to 1987 the Carter Center of Emory University joined with the Centers for Disease Control (CDC) to develop a new, probability-based, adult health risk appraisal (HRA) instrument for the public domain. This new instrument is compared with the CDC HRA version to determine which is a more accurate predictor of mortality. METHODS: We compared predicted mortality risks from the CDC HRA and the Carter Center HRA with the observed mortality among 3135 smokers and never-smoking persons, aged 25 to 60, followed from 1959 to 1979 as part of the Tecumseh Community Health Study. RESULTS: When individuals were classified according to the difference between their actual age and risk age, for the CDC HRA, there was a progressively increasing risk of 10-year mortality as the difference increased. The Carter Center HRA did not show this trend. An analysis using relative operating characteristic curves showed that the mortality risk predictions for both programs were very similar for men and women. However, differences between actual age and risk age for the two programs were not similar for men or women, particularly older men. Therefore, actual age minus risk age for the CDC program was a more accurate predictor of 10-year mortality than was this difference for the Carter Center program. CONCLUSIONS: The results from both types of analyses suggest that the validity of risk ages obtained from the Carter Center version may not be sufficient to justify updating programs for those currently using the CDC instrument.

Adult↗
PubMed1990

Matching and efficiency in cohort studies.

Contrary to the impression given in some textbooks, matching can reduce the efficiency of a cohort study, even when it produces no sample-size reduction and even if the matching variable is a confounder. The authors illustrate this along with some additional points regarding cohort matching. First, the impact of matching on efficiency can be in opposite directions for different measures of effect; as a consequence, criteria for deciding whether to match must depend on whether one wishes to estimate relative or absolute effects. Second, the commonly drawn analogy between blocking in randomized trials and matching in cohort studies is misleading when one considers the impact of matching on covariate distributions. Third, the conditions for efficiency overmatching in a cohort study are different from the conditions in a case-control study. It appears that, under an additive model, matching will usually increase the efficiency of both risk-difference and risk-ratio estimation, and the power of the Mantel-Haenszel test. Under a multiplicative model, the impact of matching is not as consistently beneficial. The authors present some approximate criteria which allow one to use a priori information to predict whether cohort matching is likely to improve efficiency.

Adult↗
PubMed1990

Predictors of improvement in tardive dyskinesia following discontinuation of neuroleptic medication.

Forty-nine chronic psychiatric out-patients (ten were schizophrenic) with tardive dyskinesia (TD) were examined monthly for a mean of 40 weeks (range 1-59 months) after discontinuation of neuroleptic medication. Complete and persistent reversibility of TD was rare (2%), but many patients showed noticeable improvement in movements within the first year of discontinuation, which was sometimes interrupted by psychological relapse. Using three separate outcome measures and appropriate model-fitting techniques for each, we identified several predictors of improvement in TD, including an affective or schizoaffective psychiatric diagnosis, chronic (over 20 years) psychiatric illness, being employed, younger age, and increased neuroleptic dose before discontinuation. Consistent findings emerging from these analyses suggest that the type and history of psychiatric illness affect the course of TD.

Adult↗
PubMed1990

Women, myocardial infarction, and dementia in the very old.

Dementia is a major public health problem among the very old. Available information on incidence and prevalence is sparse and variable; however, there appears to be a higher prevalence among very old women. We present data from a prospective study of initially nondemented community-residing elderly. There were 75 incident dementia cases (up to 7 years of follow-up) of which at least 47% were probable Alzheimer's disease. Based on a proportional hazards analysis, women were over 3 times more likely to develop dementia than men despite controlling for baseline demographic, psychosocial, and medical history variables. Poor word fluency and a high normal Blessed test score at baseline were also strong predictors of dementia. We did not find age, head trauma, thyroid disease, or family history of dementia to be risk factors. A new finding is that history of myocardial infarction (MI) is associated with dementia, such that women with a history of MI were 5 times more prone to dementia than those without a history. This observation was not true for men.

Aged↗
PubMed1989

Development of dementing illnesses in an 80-year-old volunteer cohort.

We have prospectively followed over a 5-year period 434 volunteers who were at intake ambulatory, functional, presumably nondemented, and between 75 and 85 years of age. Fifty-six (an incidence of 3.53 per 100 person-years at risk) developed a progressive dementia: 32 met diagnostic criteria for Alzheimer's disease (AD) (an incidence of 2.0 per 100 person-years at risk), 15 had vascular or mixed dementia, and 9 had other disorders or remain undiagnosed. New cases of dementia were as common as myocardial infarction and twice as common as stroke. Risk factors for both dementia and AD were age (over 80) and gender (female); other reported risk factors such as family history, prior head injury, thyroid disease, maternal age, and smoking were not risk factors for AD in this elderly cohort. Prior stroke was the major risk factor for vascular or mixed dementia; diabetes and left ventricular hypertrophy but not a history of hypertension per se were also risk factors for vascular dementia. The major predictor of the development of AD was the mental status score on entry. The 58.5% of the cohort who made zero to two errors on a 33-item mental status test had a less than 0.6% per year chance of developing AD, whereas the 16% of the cohort with five to eight errors on this test developed AD at a rate of over 12% per year. Thus, it is possible to identify a large cohort of 80-year-olds who are at low risk for AD and a smaller cohort at very high risk.

Aged↗