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Biomedical subjects

V Mor

Publications and source records attributed to V Mor.

At least 109 records · Page 6Linked to original sources
PubMed1993

Pathways to hospital death among the oldest old.

Using the 1986 National Mortality Followback Survey (N = 2,090), this research examines the conditions under which the oldest old (85+ years of age) are discharged from a nursing home to enter and die in a hospital as well as the conditions under which community dwellers enter and die in a hospital. Given the need to plan for health services for this growing population and the recent policy changes in length of hospital stay, this analysis focuses on pathways leading to a hospital death. Results suggest that the factors that influence site of death are necessarily quite distinct for those who have entered the institutional long-term care system versus those who have not. Among institutionalized patients, the incidence of an acute condition appears to precipitate hospitalization, whereas among community dwellers, the presence of a social support network and the decedent's race are the only salient factors predicting hospital death. Implications are discussed.

Aged↗
PubMed1993

The effects of immune status and race on health service use among people with HIV disease.

OBJECTIVES: The purpose of this study was to examine the relationship between CD4 lymphocyte count and health service use, and to determine whether differences in the rates of service use between Whites and people of color could be identified. METHODS: Medical records for 571 HIV-infected individuals were analyzed. Incidence rates and relative rates across CD4 strata (defined by cell counts) were calculated for inpatient and outpatient events. Rate ratios comparing people of color with Whites were estimated within strata, adjusting for confounding factors using a Mantel-Haenszel pooling procedure. RESULTS: Both inpatient and outpatient service use increased over progressively lower levels of CD4 counts. Within each CD4 stratum and controlling for other factors, White participants had more HIV clinic visits and fewer admissions than people of color. Among participants with fewer than 51 CD4 cells per cubic millimeter, people of color were admitted 20% more often, had 35% more inpatient days per person-year, and had only 74% as many HIV clinic visits as their White counterparts. CONCLUSIONS: These results indicate that CD4 lymphocyte count is strongly associated with increased usage of health services. People of color with HIV disease are more likely than similar Whites to be admitted to the hospital and less likely to use outpatient care.

Ambulatory Care↗
PubMed1993

Insurance status among people with AIDS: relationships with sociodemographic characteristics and service use.

This paper presents data on health insurance coverage among people with AIDS. The data came from interviews with 937 people with AIDS recruited from outpatient HIV clinics and community-based AIDS service organizations in nine communities across the United States. At the time of the interview, 30% had private insurance, 29% had no insurance, and 41% were covered by some form of public health insurance. Respondents who were nonwhite, injected-drug users, unemployed, and had incomes of less than $500 per month were more likely than their respective counterparts to have no insurance or to have publicly funded insurance. There were marked regional variations in insurance status, with the South having the highest proportion of of uninsured and the lowest proportion receiving Medicaid. Ninety-five percent of the uninsured and the publicly insured, compared to 47% of those with private insurance, used clinics as their source of medical care. People without insurance were less likely than those with private insurance to have been admitted overnight to a hospital, and their lengths of stay were shorter.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Factors affecting conversion rates to Medicaid among new admissions to nursing homes.

OBJECTIVE: This study examines conversion to Medicaid as a payment source among a cohort of newly admitted nursing home residents. DATA SOURCE: The longitudinal data used came from regular assessments of residents in the National Health Corporation's 43 for-profit nursing homes in Missouri, Kentucky, South Carolina, and Tennessee. This information system tracked all residents who were discharged, providing a comprehensive record that may have spanned multiple admissions. STUDY DESIGN: Using survival analysis methods, Cox regression, and survival trees, we contrasted the effect of state, initial payment source, education, age, and functional status on the rate of spend-down to Medicaid. DATA EXTRACTION METHODS: New-admission cohorts were created by linking an admission record for a newly admitted resident with all subsequent assessments and follow-up records to ascertain the precise dates of any payment source changes and other discharge transitions. PRINCIPAL FINDINGS: For the 1,849 individuals who were admitted as self-payers and who were still in the nursing home at the end of one year, there is a 19 percent probability of converting to Medicaid. All analytic methods revealed that education, age, and state of residence were predictive of spend-down among residents who were admitted as self-payers. CONCLUSIONS: Our results confirm the effect of education as an SES indicator and state as a proxy for Medicaid policy on spend-down. Future research should model the effects and duration of intervening hospitalizations and other transitions on Medicaid spend-down among new admissions.

Activities of Daily Living↗
PubMed1992

The changing needs of patients with cancer at home. A longitudinal view.

Changes in the daily living needs of 629 patients with advanced cancer were investigated (1) during and (2) 3 to 6 months after a course of outpatient chemotherapy and/or radiation treatment. The analytic sample consisted of patients completing both baseline and follow-up interviews (n = 434). At both times, the point prevalence of need and unmet need for assistance with personal care, instrumental activities, transportation, and home health tasks was calculated. In addition, the prevalence of new need and unmet need at follow-up was determined as were the rates of resolution of baseline need. The prevalence of need for assistance with personal care increased from 7% at baseline to 16% at follow-up; the dynamic of need acquisition and resolution resulted in relatively constant prevalence rates in other task areas. Acquisition of need at follow-up was associated primarily with disease and treatment-related characteristics. Approximately one third of patients reporting need for assistance during at least one interview did not have enough help. New unmet need at follow-up was associated most strongly with patients' mobility and the ability of their informal support system to provide care. The apparently rapid fluctuation in patients' experience of need and unmet need suggests the necessity for ongoing appraisal of patients' physical condition and social situation.

Adult↗
PubMed1992

Quality of life in persons with human immunodeficiency virus infection: measurement by the Medical Outcomes Study instrument.

OBJECTIVE: To assess the reliability and validity of the Medical Outcomes Study (MOS) Short Form Health Survey as an indicator for quality of life in patients infected with the human immunodeficiency virus (HIV). DESIGN: Patient interview survey. SETTING: The AIDS Health Services Program in seven sites: Newark and Jersey City, New Jersey; Nassau County, New York; Atlanta, Georgia; Dallas, Texas; Fort Lauderdale and Miami, Florida; New Orleans, Louisiana; and Seattle, Washington. PATIENTS: Patients (520) with HIV infection receiving health services at one of the above sites. MEASUREMENTS: All components of the MOS Short Form Health Survey were included in the interview. Minor modifications were made to adapt the survey to the particular circumstances of the study. Measured sociodemographic characteristics included age, sex, race, intravenous drug use, and education. Symptoms were assessed by closed-ended questions concerning memory, seizure, weakness or numbness, fever, chills, diaphoreses, dyspnea, diarrhea, and weight loss. Information on the frequency of symptoms was also collected. History of Pneumocystis carinii pneumonia and Kaposi sarcoma was noted. MAIN RESULTS: The sociodemographic characteristics resemble those of patients with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control (CDC): mean age, 36; men, 89%; nonwhite, 31%; intravenous drug use, 34%. Neurologic symptoms (memory trouble, seizures, weakness or numbness) occurred in 71% of patients; constitutional symptoms (fever, chills, night sweats, weight loss) in 69%; dyspnea in 50%; and diarrhea in 47%. Although older age, female sex, nonwhite race, and intravenous drug use were associated with lower MOS scores in several areas, the strongest single or adjusted indicator of lower MOS scores was the presence of symptoms. Finally, patients with HIV infection had significantly lower scores than did previously reported patients with other chronic medical conditions (P less than 0.001). CONCLUSIONS: The MOS survey is a reliable measure of quality of life for patients with HIV infection. These patients tend to have low scores, suggesting validity of the survey. The MOS survey is extremely sensitive to the effect of symptoms, which suggests that it might be useful as a quality-of-life indicator for AIDS clinical drug trials.

Adult↗
PubMed1992

Physical symptoms and depressive symptoms among individuals with HIV infection.

The authors investigate the importance of physical symptoms as a correlate of depressive symptoms and suicidal thoughts in a large (N = 881) community-based sample of persons infected with human immunodeficiency virus. The study overcomes limitations of prior research by minimizing overlap in measures of affective and physical symptoms, studying a more diverse population, and including correlates such as measures of social support, function, employment, insurance coverage, and cognitive impairment in the analysis. The authors' data support the notion that in diagnosing depression in the medically ill, concern over isolating physical symptoms as either "affective" or "physical" may be exaggerated.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The association of physical activity with mortality among older adults in the Longitudinal Study of Aging (1984-1988).

Self-reported physical activity/exercise and mortality among adults aged 70 and over were examined using data drawn from the 1984-1988 Longitudinal Study of Aging (LSOA). Analyses were conducted for the LSOA sample as a whole (N = 5901), for women (n = 3679) and men (n = 2222), and for persons with 1 + IADL difficulties (n = 1592). Results for the whole sample indicated that less activity/exercise was associated with a higher risk of mortality for each of four questions (activity compared to peers, have regular exercise routine, get enough exercise, days walking a mile per week). Analyses by gender indicated that all four questions were important for women, while the two questions asking for a judgment about activity were important for men. For persons with 1 + IADL impairments, walking was associated with lower mortality. This investigation supports literature on the importance of maintaining physical activity into older adulthood, and suggests that clinicians should attend to reports of activity level by their patients as one of the broader psychosocial domains of patient care.

Activities of Daily Living↗
PubMed1992

The structure and process of AIDS case management.

This article presents observations of case management in the Robert Wood Johnson Foundation AIDS Health Services Program. Case management is discussed in terms of assessment, care plan development, client links with services, monitoring, and advocacy. Recommendations are proposed to ensure that AIDS case management is delivered in a standard and equitable manner that can be monitored by quality assurance agencies.

Acquired Immunodeficiency Syndrome↗
PubMed1992

An exploratory analysis of survival with AIDS using a nonparametric tree-structured approach.

We illustrate an analysis with classification and regression trees applied to survival data. Through this application, we provide a description of the opportunistic diseases and sociodemographic factors that contribute to survival among people with human immunodeficiency virus disease. The analyses are based on 43,795 cases reported to the Centers for Disease Control between January 1, 1984, and December 31, 1987. We used vital status as of December 31, 1989, to estimate mortality rates. We identified Kaposi's sarcoma and opportunistic diseases causing central nervous system damage (cryptococcosis, primary lymphoma of the brain, cytomegalovirus disease, and progressive multifocal leukoencephalopathy) as important predictors of death. In addition, advanced age at diagnosis (50+), race (white/other), and history of illicit drug use were found to be important determinants. Estimates of the cumulative probability of survival for subgroups of individuals defined by the tree structure illustrate the effect of these determinants on mortality. For the purpose of comparison, two proportional hazards models were also fit to the data using factors identified in the tree structure as the determinants of interest. This application illustrates the utility and limitations of both this new technique and proportional hazards models for epidemiologic research.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Variation in health service use among HIV-infected patients.

The effects of sociodemographic factors on health service use among people with human immunodeficiency virus (HIV) infection are assessed. Data are from a survey of 939 clients of the Robert Wood Johnson Foundation's AIDS Health Services Program in nine communities across the country. Dependent variables are the number of outpatient visits, use of the emergency room, and whether the respondent had been admitted as an inpatient. In the 3 months before the interview, the sample averaged 7.46 outpatient physician/clinic visits: 35.9% reported an emergency room visit, and 29.9% had been hospitalized. The data suggested differential patterns of health service use, such that those who are white, male, and non-intravenous drug users have higher rates of outpatient clinic/physician use, whereas those who are nonwhite, female, and intravenous drug users have higher rates of emergency room use. Whether these observed differences are attributable to the system's response to different socioeconomic groups, or to differences in individual orientations toward use of medical care is discussed.

Black or African American↗
PubMed1992

Sampling and accessing people with AIDS. Implications for program evaluation.

This article describes issues that arose in attempting to conduct a survey of people with acquired immune deficiency syndrome (AIDS) as part of an evaluation of a program to deliver health and social services to this population. Demands to maintain the confidentiality of people with human immunodeficiency virus (HIV) infection posed a large impediment to randomly sampling and accessing program recipients. Efforts to contact people with AIDS through the mediation of health service providers encountered problems of nonimplementation and slow accrual. Comparisons of the obtained sample with a more comprehensive data base of program clients suggest that clients who were more accessible and compliant were overrepresented in the sample. People with AIDS themselves, however, were willing to be interviewed, as demonstrated by refusal rates less than 11%. Future studies of people with AIDS must overcome direct service providers' lack of time to contact and recruit respondents; it may be wise to allocate funds to support recruitment activities conducted by an administrative staff person in the service delivery agency.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Mammography for older women: who uses, who benefits?

In order to juxtapose the health, social, and behavioral factors associated with use of screening mammography with short-term mortality among elderly women, we analyzed the NHIS Cancer Epidemiology Supplemental Survey and the Longitudinal Study of Aging. After controlling for sociodemographic factors, having a usual source of care of and knowledge of screening guidelines, we found that a woman's health status is unrelated to having had a screening mammogram. Analyses of the LSOA, however, revealed that health factors were strongly related to 4-year mortality, particularly among women 75 and over. As it is unlikely that the subpopulation of older women who are at high risk of death within 4 years will benefit from a program of universal screening, outreach program messages and physician education programs should probably be designed to proactively recruit those most likely to benefit.

Age Factors↗