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Biomedical subjects

L G Branch

Publications and source records attributed to L G Branch.

119 records · Page 7Linked to original sources
PubMedDate not supplied

Prevention services received by veterans visiting VHA facilities.

OBJECTIVES: This paper presents rates with which veterans report receiving 13 recommended health promotion and disease prevention services. Results were compared with the U.S. Healthy People 2000 goals. METHODS: Random samples of 300 men and 150 women visiting primary care clinics in six Veterans Health Affairs facilities were drawn. A 66% adjusted response rate was achieved after two mailings (n = 1,703). Weighted averages for each prevention service were calculated. RESULTS: For preventive services targeted to all age groups, both male and female veterans currently exceed the Year 2000 goal in hypertension detection and tobacco counseling. Female veterans also exceed the Year 2000 goal in "almost always" using seat belts. For prevention services targeted to specific age-gender subgroups, both male and female veterans currently exceed the Year 2000 goals for four of the six primary and secondary prevention services. CONCLUSIONS: Both male and female veterans exceed Year 2000 goals for the receipt of nearly half of the preventive services. Nevertheless, additional screening and counseling services should be made available to veterans of all age categories.

Adult↗
PubMedDate not supplied

The receipt of prevention services by veterans using VA versus non-VA facilities.

OBJECTIVES: This paper compares the health promotion/disease prevention services received by veterans who reported receiving 90%+ of their care inside Veterans Health Administration (VA) facilities with counterparts who reported receiving 90%+ of their care outside VA facilities. Results are compared with the U.S. Healthy People 2000 goals. METHODS: Random samples were drawn of 300 men and 150 women visiting primary care clinics in six VA facilities. A 66% adjusted response rate was achieved after two mailings (n = 1,703). For this analysis, those veterans who reported receiving 90%+ of their care inside VA facilities (n = 909) were compared with veterans who reported receiving 90%+ of their care outside VA facilities (n = 185). RESULTS: Of the 13 health promotion¿disease prevention services, 6 were significantly influenced by source of care. Five of the significant differences reflected statistically higher prevalence rates for those receiving 90%+ of their care inside the VA (mammograms and counseling for alcohol, nutrition, exercise, and seatbelt use). One reflected a higher prevalence rate for those receiving 90%+ of their care outside the VA system (tetanus boosters). CONCLUSIONS: Veterans receiving 90%+ of their care in VA facilities obtained more preventive services than counterparts using non-VA providers. Assessment and counseling services need to be targeted to more veterans to comply more fully with U.S. Preventive Services Task Force recommendations and Healthy People 2000 objectives.

Adult↗
PubMedDate not supplied

Predictors of the use of dental services by older veterans.

By the year 2000, it is likely that more than 66% of all US males will be veterans as a result of the large World War II cohort. This growing population of older veterans will have a major influence on the use of dental services at Veterans Administration facilities. The objectives of the project reported here were to identify and examine factors that explain use of dental services by noninstitutionalized veterans older than 55 years; this was a secondary analysis of a VA commissioned survey of 3,013 community-based veterans older than 55 years. A behavioral model developed by Anderson and Aday that identified predisposing, enabling, and need factors that determined use of health care services was adopted to analyze the data. A linear regression analysis showed that need factors accounted for the greatest degree of explained variance in use of dental services (R2 = .15), whereas enabling factors accounted for the least degree of variance (R2 = .02). Perception of dental problems, positive perception of physical health, perception of ability to meet expenses, and levels of education and income were significant predictors of use of dental services. The findings of this study show the use of dental services by noninstitutionalized veterans and other noninstitutionalized older populations is influenced by similar factors. The findings can be useful in discussing and formulating dental health care policy for older veterans.

Aged↗
PubMedDate not supplied

Predicting the stroke patient's ability to live independently.

The objective of this paper is to identify those variables that best predict a stroke patient's ability to live independently following his/her discharge from medical rehabilitation. The paper draws heavily on a formal research model grounded in independent living (IL) theory. Independent living is defined and operationalized as (1) the patient's ability to live in a nonrestrictive environment and (2) the patient's ability to live productively--not only in terms of gainful employment but also in terms of other contributions to community and family life. The main data source for the study is an extensive computer file of 84 stroke patients discharged from 8 medical rehabilitation centers. The multivariate statistical analysis indicates that 56 to 80 percent of the variance in a patient's ability to live independently can be explained or predicted mainly by the patient's marital status, age, Barthel score, communication impairments, and the ability to get into a motor vehicle. The paper concludes by discussing the implications of the findings for medical rehabilitation and public policy.

Analysis of Variance↗
PubMedDate not supplied

Factors influencing the effectiveness of mailed health surveys.

The authors investigated sources of bias in health surveys by examining responses to their 1989 questionnaire mailed to 1,255 Massachusetts men who were eligible for dental care provided by the Department of Veterans Affairs. After a maximum of three mailings and one telephone call to nonrespondents, a total of 1,049 veterans had responded out of 1,228 finally determined to be eligible, a response rate of 85 percent. The investigators found that small differences in univariate estimates would have occurred had the field phase been terminated after the first mailing, which had a response rate of 61 percent. To evaluate multivariate distributions, they duplicated their previously published logistic regression model for sources of dental care, using only those who responded to the first and second mailings. Although model fits would have been substantively the same had the field phase been terminated after the first or the second mailings, analysis of parameter estimates and their statistical significances suggested bias that would have led to different substantive conclusions, in some instances. Another potential source of bias in surveys was found to be item omission. Fifty-eight percent of respondents answered all 46 survey questions, and 90 percent answered at least 91 percent of the questions. Fewer questions were answered by those whose responses were received last, but trends regarding missing data by age or education were not statistically significant. Although the survey using this methodology met all objectives, subject nonresponses, the ineligibility of potential respondents, item nonresponses, and skewed distributions of outcome variables combined to reduce the statistical power to detect differences among groups or to alter the analysis of the differences. These factors need to be planned for by investigators undertaking similar surveys.

Analysis of Variance↗
PubMedDate not supplied

A comparison of elderly participants in a community survey with nonparticipants.

In 1982-83, 4,485 persons ages 65 or older were identified by a household census in East Boston, MA: 3,812 (85 percent) of them responded to a health and social status questionnaire. Data on age, sex, and living arrangements for the 4,485 eligible people were analyzed with respect to final participation status and reason for refusal or reluctance. The health and social status of reluctant and ready self-respondents were compared, and respondents-by-proxy were compared with self-respondents. Total participation rates were similar for both sexes and all ages, but the likelihood of interview by proxy increased with age, as did the likelihood of nonparticipation due to unavailability. Living alone or with other participants favored participation, and living with refusers or other nonrespondents increased the probability of refusal. While reluctant and ready self-respondents differed in only one health variable and two social variables, respondents-by-proxy differed from self-respondents in most variables tested. These analyses suggest an absence of major differences between self-respondents and refusers. Therefore, nonresponse bias is not likely to have a major impact on interpretation of the data obtained from participants in this study.

Aged↗
PubMedDate not supplied

A multistate analysis of active life expectancy.

With today's lower mortality rates, longer expectations of life, and new medical technologies, the nation's health policy focus has shifted from emphasis on individual survival to emphasis on personal health and independent living. Using longitudinal data sets and new methodological techniques, researchers have begun to assess active life expectancies, estimating not only how long a subpopulation can expect to live beyond each age, but what fractions of the expected remaining lifetime will be lived as independent, dependent, or institutionalized. New ideas are addressed, applying recently developed multistate life table methods to Waves One and Two of the Massachusetts Health Care Panel Study. Expectations of active life are presented for those 65 and older who initially are in one of two functional states of well-being. Included are expectations of life, for those, for example, who were independent and remained so, or those who were dependent and became independent. Although public health officials are concerned about the number of elderly who cease being independent, preliminary analysis shows that a significant number of the dependent elderly regain their independence, a situation which needs to be addressed in health care planning.

Activities of Daily Living↗