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Biomedical subjects

M G Kovar

Publications and source records attributed to M G Kovar.

At least 19 recordsLinked to original sources
PubMed1991

Functional ability and the need for care: issues for measurement research.

Measuring the prevalence of functional disability among older people is extremely important. The number of older people is projected to increase in both the developed and the developing countries. The incidence and prevalence of functional disability are high among older people, and they are higher at older ages. Many countries plan to care for their impaired older populations. They need good information to plan for their care. The available data are soft. They are often fragmentary and based on research done 20 or 30 years ago when conditions were different. Data may not take into account the differences among people living in widely varying cultures. Nevertheless, the available data, including data from longitudinal studies, have started to yield useful information. Cross-national studies can only increase the value of the information that many people have devoted enormous resources to obtain. People should devote their time to cross-national comparisons, with the respect for the careful study of survey design, question wording, and tabulation that has been addressed in this paper. Researchers should also devote time to considering whether questions appropriate in one culture are equally appropriate in another. Investigating such issues is one of the purposes of this conference.

Activities of Daily Living↗
PubMed1990

Slowdown in the decline of stroke mortality in the United States, 1978-1986.

The gradual decline in stroke mortality rates observed in the United States since 1900 accelerated markedly around 1973 for whites and around 1968 for blacks. During the next decade stroke mortality rates decreased by almost 50% so that the United States now experiences one of the lowest stroke mortality rates in the world. Beginning in 1979, however the annual rate of decline in stroke mortality began to slow considerably. Comparing the period 1979-1986 with the previous decade, a 57% slowing in the absolute rate of decline (as estimated by the slope of the linear portion of the mortality curve) was observed for white men; the corresponding slowdowns in the rate of decline were 58% for white women, 44% for black men, and 62% for black women. If the decline during the 1980s had continued at the rate observed for the period 1968/73-1978, there would have been 131,000 fewer stroke deaths during the period 1979-1986, 28,000 fewer in 1986 alone. This slowdown in the rate of decline in stroke mortality is occurring while mortality rates for both coronary heart disease and all causes are leveling off. The reasons for this change in the mortality trend remain unknown, and corresponding trends in the treatment and control of hypertension do not provide an entirely satisfactory explanation.

Age Factors↗
PubMed1989

Longitudinal study of physical ability in the oldest-old.

Based on 1984 data from the Longitudinal Study on Aging, one-third of White persons aged 80 or older living in the community (N = 1,791) were defined as having no difficulty in walking 1/4 of a mile, in lifting 10 pounds, in climbing 10 steps without resting, or in stooping, crouching or kneeling. Physical ability was associated with lower risk of death over two years mean follow-up; Relative odds (RO) = .4 (95 percent confidence interval = .4, .6) and in survivors, lower utilization of hospitals RO = .4 (CI = .3, .7), physicians RO = .6 (CI = .5, .8) and nursing homes RO = .3 (CI = .2, .5) compared with those having difficulty on any of the four functional measures included in the definition of physical ability. Fifty percent of the women and 42 percent of the men physically able at the time of the baseline survey in 1984 remained physically able at follow-up. Continued physical ability in this group was associated with never having had cardiovascular disease RO = 2.1, (CI = 1.2, 3.7), never having had arthritic complaints RO = 1.9 (CI = 1.2, 2.7), a body mass index less than the 75th percentile RO = 1.8 (CI = 1.2, 2.9), younger age (for each decade of age, RO = 2.0 (CI = 1.1, 3.6), and higher level of education (greater than 13 years versus 0-6 years) RO = 2.4 (CI = 1.2, 4.7). These correlates include factors amenable to preventive measures and highlight the need to consider the heterogeneity of the oldest-old in formulating programs aimed at prevention and postponement of disability.

Activities of Daily Living↗
PubMed1988

Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States.

Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (delta rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other three race-sex groups. During 1976-85 there was also a leveling off in the average annual per cent change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade.

Adult↗
PubMed1987

The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey.

Immediate hypersensitivity skin tests to eight select allergens were performed on a sample (N = 16,204) of the civilian noninstitutional population of the United States, 6 to 74 years of age, in the second National Health and Nutrition Examination Survey (NHANES II). The eight allergens were house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial ryegrass, and Bermuda grass. Skin test reactivity was defined as a mean erythema diameter greater than or equal to 10.5 mm at the 20-minute reading. Overall, 20.2% of the participants reacted to at least one allergen. Peak reactivity occurred in the 12 to 24-year-old age group. Reactivity was higher in blacks versus whites, but the difference did not reach statistical significance (23.2% versus 19.8%; p greater than 0.05). Male participants had an increased prevalence of reactivity versus female participants in whites (22.0% versus 17.6%), but not in blacks (23.2% versus 23.3%). Skin test reactivity increased in both whites and blacks with increasing income and education. The prevalence of skin test reactivity was higher in urban versus rural areas, but the difference was statistically significant only for whites (whites, 21.6% versus 16.4%; blacks, 23.8% versus 18.4%; p greater than 0.05). With logistic regression, the most important predictors of skin test reactivity in whites were age, sex, urban residence, and poverty status. In blacks, the most important predictors were age, urban residence, and poverty status.

Adolescent↗
PubMed1986

Expenditures for the medical care of elderly people living in the community in 1980.

Policy debates about financing medical care for the elderly are often clouded by evidence drawn from averages based on aggregate data. The National Medical Care Utilization and Expenditure Survey enables examination of the circumstances of the 95 percent of the elderly who are not institutionalized. A significant portion of out-of-pocket charges falls on the poor; public expenditures are highly concentrated for the relatively few elderly in their last year of life. Medicare and Medicaid have successfully lessened the burden on families.

Aged↗
PubMed1978

A comparison of 1960 and 1973--1974 early neonatal mortality in selected states.

Linked birth and infant death records from six states provided the opportunity for comparison of 1960 and 1973--1974 early neonatal mortality rates by weight, maternal age and live birth order. The data were analyzed by fitting linear models to the logarithm of the ratio of 1960 to 1973--1974 early neonatal mortality rates. Although there was substantial variability in these ratios by maternal age and birth order, the ratios were nearly constant for birth weights between 1001 and 4500 gm. The decline in mortality among low birth weight infants (2500 gm or less) accounted for over half of the overall decline in early neonatal mortality. The results obtained here are compared with earlier national studies and possible explanations for the decline are discussed.

Adolescent↗
PubMed1976

Reproductive efficiency as a social indicator.

An index of reproductive effiency (RE) is proposed as a social indicator that will meet the need to consider various forms of pregnancy wastage, to compare their relative costs, and to guide reproductive health policy accordingly. This article discusses conceptual and measurement aspects of RE. Conversion of wanted to unwanted pregnancies and the reverse, interpretation of abortion in relation to other pregnancy outcomes, defining the end point for the reproductive process and criteria for the events to be included as significant outcomes are conceptual issues. Measurement problems include: whether aggregation is justified, prospective and retrospective tracking of outcomes, record limitations, duplication of adversities in a single pregnancy, and selection of optimal rate for comparison. A measurement of RE for the entire United States based on the National Natality Survey of 1964-1966 is presented, showing 74.5 percent of pregnancies resulting in healthy liveborn infants. For those years, data on abortions could not be included. Within the group of reported pregnancy losses, the importance of congenital abnormalities and low-birth-weight babies is enhanced by application of economic weights based on associated medical care costs. Changing opportunities for birth timing, prenatal and infant care, and control of family size are social means of reducing adverse outcomes associated with teenage pregnancy and high-parity births, often found together with poverty. Successive increments in RE may be progressively more expensive to achieve, and cost effectiveness comparison will be necessary.

Abortion, Legal↗