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Biomedical subjects

T E Stump

Publications and source records attributed to T E Stump.

33 records · Page 2Linked to original sources
PubMed1996

Age and the sense of control among older adults.

Older adults are expected and frequently found to report less control than younger adults. In this study, we decompose this negative relationship between age and sense of control using nested multivariable linear regression models that serially introduce sociodemographic characteristics, socioeconomic factors, health status, and subjective religiosity and religious beliefs in a sample of 1,051 older adults attending the general medicine clinics of a major medical center. The results indicate that the effect of age is suppressed in the bivariable model. In the final multivariable model, educational attainment has the largest relative effect (i.e., beta; .253), followed by age (-.210), mental health (.174), subjective religiosity (.113), being an African American (-.100), perceived health (.082), and being Catholic (.068). Future research should focus on the inflection point in the relationship between age and the sense of control that apparently occurs at about 50 years of age.

Aged↗
PubMed1996

A measurement model of the Medical Outcomes Study 36-Item Short-Form Health Survey in a clinical sample of disadvantaged, older, black, and white men and women.

The authors assess the factorial validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) for use in a clinical sample of disadvantaged, older adults with significant comorbidities. Confirmatory factor analysis was performed using LISREL VIII on data obtained from baseline face-to-face interviews with a clinical sample of 1,051 patients who were at risk for acute deterioration of their clinical condition due either to their age alone (75 years or older), or to their age (50 to 74 years old) and major comorbid conditions. An acceptable eight-factor measurement model reflecting the original specification (ie, subscales) of the SF-36 was obtained (chi-square to degrees of freedom ratio = 2.14; root mean squared residual = .055; adjusted goodness of fit index = .90). That model, however, required relaxing the assumptions associated with seven correlated error terms. Moreover, an alternative nine-factor model that allowed the ¿getting sick¿ and ¿getting worse¿ items to form their own factor, labeled ¿health optimism,¿ fit the data significantly better (8 degrees of freedom chi-square improvement = 61; P< 0.0001). Although continued use of the SF-36 in older, disadvantaged, clinical samples is appropriate, further assessment of the underlying measurement model in other samples using confirmatory factor analytic techniques is needed to resolve the issue of correlated error structures and the existence of the health optimism factor.

Black or African American↗
PubMed1996

Consistency and change in functional status among older adults over time.

Consistency and change between 1984 and the last reinterview (either two, four, or six years later) on 22 individual functional status markers and the five summary scales that they form are examined among the 5,986 members of the Longitudinal Study on Aging who were reinterviewed at least once. At baseline, at least three-fifths of the respondents are without limitations on any individual marker. At the last reinterview, at least 43.4% of the respondents are without such limitations. Among those who had limitations at baseline, at least one-fifth get better. For those without limitations at baseline, one-seventeenth to two-fifths get worse. Difficulties in walking and doing heavy housework were the most common, most likely to develop, and least likely to resolve of any of the ADL or IADL items, and lower body limitations were more common, more likely to develop, and less likely to resolve than upper body limitations. Linear panel analysis of the five summary scales indicates that the top predictors of increased functional limitation are baseline levels of functional limitation, older age, decedent status, and poorer perceived health (in that order). Other less consistent and less robust predictors include the length of the exposure window, being female, having a history of arthritis, lower educational attainment, having fewer nonkin social supports, higher prior physician visit levels, and not living alone.

Activities of Daily Living↗
PubMed1995

Changes in physician utilization over time among older adults.

Although much is known from cross-sectional studies about the use of physician services among older adults, little is known about the consistency of or changes in that utilization over time. Hierarchical multivariable regression analysis of data on the 2,430 older adults who were enrolled in the LSOA and successfully reinterviewed in 1986, 1988, and 1990 is used to model changes in the number of physician visits between 1984 and 1990 based on the predisposing, enabling, and need (including functional status) characteristics measured in 1984, and subsequent changes in functional status. Overall, 19 percent of the variance in physician utilization is explained, with 8 percent coming from the introduction of the need characteristics, 4.7 percent from the subsequent introduction of the number of physician visits at baseline, and 4.9 percent from the subsequent introduction of changes in functional status. Declines in each of the functional status measures are significantly associated with increases in physician utilization, although improvements are fundamentally unrelated.

Activities of Daily Living↗
PubMed1995

Hospital utilization profiles among older adults over time: consistency and volume among survivors and decedents.

Medicare claims data are used to model hospital utilization patterns for the 4,660 survivors and 2,867 decedents of the Longitudinal Study on Aging (LSOA). When the volume of hospital utilization was collapsed into four categories based on the mean annual number of hospital episodes and consistency was defined as a maximum absolute deviation from that mean of 1.5 or less, 42.6 percent of the LSOA respondents were found not to have any hospital admissions, and another 24.7 percent were found to be consistently low users. Only 4.8 percent were consistently high users, with an additional 6.8 percent being inconsistently high users. Multiple regression identified prior physician and hospital utilization, as well as poor perceived health, as the most important predictors of the volume and consistency of hospital utilization among survivors, as well as of the volume of hospital utilization among decedents. Among decedents, consistency was primarily related to geographic region and prior physician utilization.

Activities of Daily Living↗
PubMed1995

The risk of mortality among older adults over an eight-year period.

Mortality risks over an 8-year period are assessed among the 7,527 older adults interviewed as part of the Longitudinal Study on Aging. Using a modified version of the behavioral model, hierarchical methods are used to sequentially introduce the predisposing and enabling characteristics, disease history, disabilities and functional limitations, perceived health, and health services utilization both at and after baseline. Based on their partial r statistics (shown in parentheses), the proportional hazard analyses identify the mean annual number of hospital episodes after baseline (.13), age (.07), female gender (-.05), non-kin social supports (-.03), body mass (-.03), and having a history of diabetes (.03) as the six most salient predictors. These six variables account for 80% of the overall model fit.

Activities of Daily Living↗
PubMed1995

Antecedents and consequences of physical activity and exercise among older adults.

The antecedents and consequences of four markers of physical activity and exercise are examined for the 6,780 baseline self-respondents to the Longitudinal Study on Aging. These dichotomous markers reflect having a level of physical activity greater than one's peers (45.8%), getting as much exercise as needed (58.9%), having a regular exercise routine (28.4%), and walking a mile or more at least once a week (29.9%). The major factors associated with engaging in these behaviors are having fewer lower body limitations, better perceived health, more non-kin social supports, not worrying about one's health, and having a sense of control over one's health. When added to traditional models predicting subsequent (over the next 6 to 8 years) mortality, nursing home placement, hospital resource consumption, and changes in functional status, the four markers of physical activity and exercise have numerous statistically and substantively significant associations, all of which involve better health outcomes.

Aged↗
PubMed1993

Thoracic complications of dental surgical procedures: hazards of the dental drill.

CASE REPORTS: Dental surgical procedures occasionally result in intrathoracic complications that may subsequently be encountered by clinicians. We report four patients with such complications, including pneumomediastinum, fatal descending necrotizing mediastinitis, and Lemierre's syndrome. In each of these patients, the commonly used dental handpiece with exhausted air directed to the working drill point was an important, but unrecognized, predisposition to their intrathoracic complication. CONCLUSION: Clinicians should be aware of the spectrum of these problems and, in particular, of the potential hazards of pressurized nonsterile air blown into open surgical sites by the dental drill.

Adolescent↗
PubMed1988

Comparison of parotid and minor salivary gland biopsy specimens in the diagnosis of Sjögren's syndrome.

We conducted a prospective study comparing minor salivary gland and parotid gland biopsy specimens obtained simultaneously from 24 patients who were undergoing evaluation for primary Sjögren's syndrome (SS). Adequate tissue for study was obtained with all minor salivary gland biopsies and 19 of 24 parotid gland biopsies. Parotid inflammation was seen in 6 of 11 patients whose minor salivary gland biopsy results indicated SS, but in none of 8 patients who had normal findings on minor salivary gland biopsy. Patients with parotid inflammation were older and had a higher frequency of dry eyes and mouth, abnormal results on Schirmer's test, serious extraglandular involvement, and serologic abnormalities. We conclude that parotid gland biopsy adds very little to the minor salivary gland biopsy in the diagnosis of primary SS, but that parotid inflammatory changes may reflect disease duration and/or severity.

Aged↗
PubMedDate not supplied

Interstitial radioactive implants for oral and oropharyngeal cancer: dentistry's role.

Five patients with oral or oropharyngeal cancer were treated with external beam radiation therapy and interstitial radioactive implants as part of their tumor management. The radiation oncologists used various radioisotopes and techniques for placement. Local anesthesia, and in most cases conscious sedation, were used instead of general anesthesia to insert the implants. The dental team, working in conjunction with the radiation oncologists, was able to provide this service which resulted in safe, cost-effective care for the patients.

Aged↗