Oral health impact on quality of life: methodological and conceptual concerns.
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Biomedical subjects
J Karuza
Publications and source records attributed to J Karuza.
Toward a new research agenda for geriatric dentistry under the current health care scene.
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Contextual and psychosocial issues in choice of dental service delivery modes.
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Relative preference and adaptiveness of behavioral blame for observers of rape victims.
Observers viewed one of nine dramatized videotaped interviews of a rape victim describing her rape. Information in the interview varied the prudence of the victim's behavior (careful, careless, no information provided) and the respectability of her character (good, bad, no information provided). Behavioral blame was significantly greater than characterological blame when the victim was careless or when no information was provided about behavior, regardless of the victim's character. When the behavior was careful, behavioral blame was equal in magnitude to characterological blame. In no case was characterological blame preferred. The adaptive value of behavioral blame for preserving a belief in a controllable and meaningful world was examined using a hierarchical multiple regression. After removing the effects of the prebeliefs of the subjects and the independent variable manipulations, only behavioral blame was significantly related to the maintenance of adaptive beliefs. Implications of the adaptive value of behavioral blame are discussed along with the importance of distinguishing observers' behavioral and characterological blaming strategies in the victimization literature.
Adaptation, Psychological↗
Enhancement of leader power after election or appointment to undersirable leader roles.
Sixteen groups of male and female university students (N= 129) were tested in a 2 by 2 design which varied mode of leader selection (election vs. appointment) and desirability of leader role (desirable vs. undersiable). Desirable leader roles were created by offering $5.00 and extra experimental credit for extra work to be completed on the leader's own time. Leaders in undersirable roles had to complete the extra work without pay or experimental credit. After a warm-up task, a confederate was either elected or appointed leader. On two subsequent tasks the leader made three influence attempts on (a) the task structure, (b) the task content, and (c) the members' willingness to volunteer to help the leader with the extra work. Results indicated that on all influence measures individuals elected to the undersirable leader role had significantly greater social power than individuals elected to the desirable role. Desirability of the leader role did not significantly affect the social power of appointed leaders.
Achievement↗
Assessment of preventive health care: design considerations.
OBJECTIVE: To design an instrument to assess the performance of a clinic in the delivery of preventive health services to a general population. METHODS: The study utilized a chart review of services delivered, abstraction of data from electronic databases, and a standardized provider assessment of each eligible patient. The study was conducted in a primary care clinic staffed primarily by internal medicine residents in an urban academic medical center. Patients who were receiving continuity care in the clinic and who were scheduled for an appointment during the 2-week study period were eligible for inclusion. Patients were identified prospectively from the appointment schedule. Charts were reviewed for the delivery of preventive health services prior to the patient's visit. Assessment forms were provided to the primary providers for review and completion. Demographic and appointment information was electronically abstracted from current databases. RESULTS: The rate at which services were provided varied considerably by service and over time. The reasons for nondelivery included disagreement with guidelines, patient resistance/refusal, and lack of priority. CONCLUSIONS: It should be possible to assess a clinic's performance over a range of services over its entire population over time. There may be legitimate reasons for services not being provided to a sizable proportion of the population. These issues are complex and require sensitive detailed investigation.
Adult↗
Residency education in the nursing home: a national survey of internal medicine and family practice programs.
OBJECTIVE: To assess the role of the nursing home in postgraduate medical education. DESIGN: A survey questionnaire addressing the following issues: 1) prevalence of nursing home rotations in internal medicine and family practice residency programs, 2) duration and type of rotation, 3) extent of residents' responsibilities, 4) patterns of faculty supervision, 5) program directors' assessments of nursing home experience, and 6) frequently encountered problems. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs in the United States. MEASUREMENTS AND MAIN RESULTS: A total of 502 surveys were returned for a response rate of 60%. Nursing home rotations were more frequent in family practice programs (87%) compared with internal medicine programs (32%). Rotations in internal medicine were generally optional and limited to a short block of time compared with family practice, where rotations were most often required and longitudinal. Internal medicine residents received more intense supervision, whereas family practice residents had greater clinical responsibilities. Few faculty had formal geriatric training or certification. Reimbursement for physician services was low. Although availability of faculty, resident interest, and conflict with other clinical services were identified as problem areas, program directors in both internal medicine and family practice were supportive of nursing home rotations for their trainees.
Data Collection↗
Oral-surgeon-reported incidence of complications related to simple extractions in adults.
This study examined the incidence of complications related to simple forceps extractions in male and female adults. A total of 413 patients (156 young adults, 150 middle-aged, and 107 older adults) presenting for extraction in the practices of 20 privately practicing oral surgeons was followed prospectively for a 30-day period. A total of 74 patients had complications. No age differences were found in the incidence of operative or postoperative complications. Reasons for extraction, number of teeth extracted, or the time required for extraction did not vary among the age groups. Oral surgeons were more likely to prescribe postoperative analgesic medications to patients already on medications. Tendency to prescribe analgesic medications was unrelated to patient age. Results indicate that among community-dwelling adults, age is not a risk factor for complications resulting from simple extractions.
Adult↗
Impacting quality: assessment of a hospital-based geriatric acute care unit.
This article describes a preliminary evaluation of the effectiveness of an inpatient geriatric acute care service (GACS) unit specifically designed to care for elderly nursing home residents. The study employed a retrospective, matched-control group design. Two separate control groups were used to provide a more thorough picture of the effectiveness of the GACS. Subjects for the study included a GACS "intervention" group consisting of 334 residents from nineteen nursing homes, an acute care "other hospital" control group consisting of 309 residents from the same nursing homes as the intervention group who were treated at other area hospitals, and an acute care "same hospital" control group, consisting of 74 matched nursing home residents who were hospitalized at the same hospital, but in a different unit than the intervention group. The length of the first hospitalization, the total length of stay during the study period, the number of rehospitalizations of the patients, and mortality were examined. Patients treated at the GACS were less likely to die, had shorter lengths of stay, less rehospitalization, and longer times between hospitalizations than both of the control groups. The GACS unit is a successful answer to the complex acute hospital care needs of the elderly nursing home population.
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Patient outcomes in hospital-based respite: a study of potential risks and benefits.
BACKGROUND: Primary care physicians provide increasing care for elderly patients with chronic disabilities. To maintain these individuals in the community, families and other caregivers are supplying more intensive support in the home. Services, such as short-term respite care, can relieve the caregiver burden and allow the patient to continue community living. Whether hospital-based respite can be an effective option for patients is unclear. METHODS: To determine the patient outcomes in hospital-based respite, 15 elderly male respite patients (mean age 71 years) were matched and compared during a 6-month period with 14 elderly acute care control patients and 16 community-based elderly control patients who were chronically ill and were enrolled in a hospital-based home-care program. RESULTS: The average respite stay was 15 days. The respite group did not experience increased risk of mortality or iatrogenesis. Benefits at 6 months included fewer admissions for acute medical care for the respite group (P less than 0.05). Total number of hospital days was equivalent for the respite group and community-based control patients and was fewer than that for the acute care group. CONCLUSION: The results do not indicate any harm and argue that a slight benefit is associated with hospital-based respite for chronically ill older adults. Because of potential complications that can develop for chronically ill geriatric patients, a hospital setting for respite can be a viable respite alternative. A valid concern for physicians, however, remains the potential danger of a greater rate of iatrogenic illness and expectation of more aggressive care based on a tertiary care model.
Activities of Daily Living↗
Gender of physicians and patients and preventive care for community-based older adults.
BACKGROUND: This study was undertaken to determine whether the gender of patients and physicians is a significant factor in deciding which older adults are offered preventive care. METHODS: A survey of medical records of ambulatory patients older than 60 years was performed in the practices of 210 physicians. Documentation of influenza vaccine, rectal examination, fecal occult blood test, Papanicolaou smear, pelvic examination, breast examination, mammogram, and pneumococcal vaccine was recorded, and rates of compliance were evaluated by sex of patient and physician. RESULTS: The medical records of 3327 patients were surveyed. Men were given influenza and pneumococcal vaccines more frequently than women. Among physicians, women physicians were more likely to give influenza vaccine (P = 0.003) and to check for fecal occult blood (P < 0.001). No significant difference was found between men and women physicians in the frequency of doing Papanicolaou smears, breast examinations, rectal examinations, and mammograms. CONCLUSIONS: While a difference in practice patterns was found between men and women physicians, most of the variance in compliance with preventive care guidelines was unexplained by the gender of physicians and patients. Matching of physician and patient by sex did not predict improved preventive care, indicating that other factors are involved in the failure to provide adequate primary preventive care to the ambulatory elderly.
Age Factors↗