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Hip fractures among older people: do marital status and type of residence matter?

This study analysed the extent to which civil status and type of residence affect the risk of elderly people sustaining a hip fracture. The study population consisted of all residents, aged 65 years or older, living in Stockholm County in Sweden between the years 1993 and 1995 (about 250,000 in total). Cases of hip fractures in the County's outpatient register (1993-1995) were linked to national registers, enabling injured people to be attributed a marital status (during year of injury), and also a size of dwelling and form of residential entitlement (in 1990). Gender-specific injury rates for three age groups were computed, as were age-standardized odds ratios (ORs) by gender for each variable of interest. As expected, hip fractures were found to rise with age among both men and women, and the risk of women sustaining such injuries was higher than that of men for all age groups. The proportion of injured men and women was higher among the unmarried than the married, and the majority of the injured were in rented accommodation (in all three age groups). The age-standardized ORs showed that the risk of hip fracture was substantially affected by civil (marital) status, but form of residential entitlement and size of dwelling did not affect the risk to any remarkable extent. The study demonstrates that being unmarried increases the risk of hip fracture among older men and women. This suggests that elderly unpartnered people may have a different daily-life pattern and may be in poorer health, both of which may be associated with a diminished social network.

Aged↗

The role of socio-economic status and place of residence in total hip replacement.

The influence of socio-economic status and place of residence on walking ability, performance of daily activities and the aid required in these activities were evaluated among 539 total hip replacement (THR) patients. The walking ability of patients of higher socioeconomic status and of urban origin was better than that of patients of lower socio-economic status and of rural origin, both before and after THR. There were no significant interclass differences in the improvement in walking ability. The same pattern was valid as regards preoperative and postoperative performance of daily activities and the need for assistance. Neither socio-economic status nor place of residence had any significant influence on the improvement in the performance of daily activities or on the decrease in use of an aid. Earlier total hip replacement is recommended for patients of lower socio-economic status and for those living in rural areas.

Activities of Daily Living↗

[Health status of the residents in the area polluted by fluorine-containing discharges from the Tajik aluminium producing plant].

The paper presents the results of investigations and follow-up monitoring to study the environment-human health relationships in the vicinity of an aluminium plant to substantiate a complex of preventive and health-promoting measures. Experience in planning and organizing the monitoring of environmental pollution and the health status of workers and the general population may be useful in doing the same work in the vicinity of other aluminium-making works.

Adolescent↗

Immunologic and other biological parameters as a function of smoking status and of residence in areas differing in terms of air pollution.

In the industrial region of La Louvière (Belgium), healthy persons, presenting at a consultation of preventive medicine, showed differences as a function of smoking and of residence in one of four areas differing in sources of emissions, population density and green zones. Smokers had significantly (P</=0.05) more leukocytes microl(-1), neutrophils microl(-1), CD3+ lymphocytes (lys) microl(-1), CD4+ lys microl(-1), CD25+ lys microl(-1), higher CD4/CD8 ratio's and higher carcino-embryonic antigen serum levels but significantly lower IgG immunoglobulin and serum carotene levels than non-smokers. Compared to persons living in the 'Peripheral area', and after correction for sex, smoking status and age, persons living in the more polluted areas showed significantly more CD3+CD56+ lys microl(-1). Although about the same mean value for the CD4/CD8 ratio was found for the more polluted areas, a higher percentage of their residents showed a ratio that was either <1 or >/=2.25, significantly so for the Power Station-Landfill area. A non-significant but consistent trend towards higher lymphocyte and CD8 lys counts and higher complement C3c serum levels further suggested an association between residence in a more polluted area and immunologic features. The number of CD3+CD56+ lys microl(-1), reported to be increased in cancer patients, showed a negative correlation with the CD4/CD8 ratio (r(2)=0.132, P<0.0001).

Adult↗

The relationship of residency performance to match status and US versus international graduate status.

BACKGROUND AND OBJECTIVES: This study compared the performance of family practice residents selected through the National Resident Matching Program (NRMP) with those selected outside the NRMP and that of US medical graduates (USMGs) versus international medical graduates (IMGs). METHODS: Surveys were mailed to all 470 US family practice residencies asking Match status and USMG versus IMG status of graduates accepted into their programs from 1994-1996. RESULTS: Of 3,222 residents, 2,815 (87.4%) were accepted through the Match, 159 (4.9%) before the Match, and 248 (7.7%) after the Match; 2,874 (89.2%) were USMGs, and 348 (10.8%) were IMGs. Residents accepted after the Match versus residents selected through the Match were more likely to leave their programs early (14.5% versus 4.8%), score in the lower 10% of their In-training Assessment Examination (ITE) (11.7% versus 2.2%), and require remedial programs (12.9% versus 2.6%). A lower proportion of residents accepted after the Match scored in the top 10% on the ITE examination (5.6% versus 15.2%). IMGs were more likely than USMGs to leave the program be fore graduating (8.0% versus 5.2%), to score within the lower 10% on the ITE examination (7.8% versus 2.5%), and to require remedial programs (7.8% versus 3.2%). CONCLUSIONS: Although a large majority of the residents studied here performed well, somewhat less-favorable performance was seen among residents accepted after the Match and among those with international medical degrees.

Chi-Square Distribution↗

Radiology residents' research in Canada: status of infrastructure.

OBJECTIVE: To survey all Canadian radiology residency training programs concerning their programs in research and critical inquiry, in order to assess the status of the research infrastructure for residents. METHODS: A questionnaire was developed through consensus among the radiology research directors in Canadian training programs. RESULTS: Fourteen of the 16 universities have a research and critical inquiry program, although there is considerable variation in the components and structure of the programs. Many programs do not have personnel, funds or written guidelines for their operation. Didactic aspects of research, such as biostatistics, ethics and quality assurance, are widely taught and thought to be important. Similarly, there is widespread agreement on which methods qualify for research projects, such as departmental audits or retrospective chart reviews. However, except for requiring a presentation at a research day, very few residency programs view research work as essential to the completion of training. The commitment to research programs is strong, as evidenced by the time devoted by residents and mentors and the funds made available for presentations. CONCLUSION: This survey provides information to assist in the development of individual programs and national guidelines for radiology residency programs in critical inquiry and research.

Canada↗

Zinc anc copper status of Polynesian residents in the Tokelau Islands.

Analyses for zinc and copper were performed in samples of serum, hair, toenails, and a 24-hr urine from Polynesian men and women resident in the Tokelau Islands. Selection of subjects was according to rank of systolic blood pressure obtained in a previous survey. The only difference in zinc anc copper values between the men and the women was a higher hair zinc concentration observed for the men. Rank of blood pressure had no influence on the measurements for zinc or copper, although within blood pressure ranks the men again had a higher hair zinc concentration than the women. Analysis of Tokelauan foods showed that most contained very low concentrations of zinc anc also low concentrations of copper. Octopus was one of the few rich sources of zinc and copper. Estimated daily dietary intakes (excluding water) were 4.5 mg Zn and 1.5 mg Cu. The reliability of measurements in serum, urine, hair, and toenails for assessing zinc and copper status is questioned.

Adult↗

Self-perceived health status of hostel residents: use of the SF-36D health survey questionnaire. Hanover Project Team.

As part of a project to assess the health needs of homeless people in Sheffield, a survey of hostel residents was undertaken with the aim of measuring self-perceived health and health service use among respondents. The survey instrument incorporated the SF-36D short-form health survey questionnaire. One hundred and four (56 per cent) adult hostel residents responded. Respondents reported high levels of health service use, and poor average perceived health in comparison with the general population. Three-quarters of respondents were identified as being at risk of major depressive illness. There was a strong association between risk of major depression and recent hospital contact, current use of prescribed medication, and low scores on the social function, mental health, energy/vitality, pain and general health dimensions of the SF-36. The implications of these findings are discussed.

Adult↗

Tobacco consumption and its association with illicit drug use among men in Bangladesh.

AIMS: This study examined the association of tobacco consumption (smoking and chewing) with illicit drug use among Bangladesh males. DESIGN: Cross-sectional survey data from the Bangladesh Demographic and Health Survey 2004 were used. SETTING: Bangladesh. PARTICIPANTS: A total of 4297 males aged 15-54 years. MEASUREMENTS: Age, education, religion, marital status, place of residence; tobacco consumption such as cigarette and bidi smoking, chewing sada, pata, tobacco leaves, gul, betel quid with zarda; taking illicit drugs such as ganja, charas, heroin, pethedine, phensidyl; having sexually transmitted diseases (STDs). FINDINGS: Overall prevalence of tobacco consumption was 59%. Bidi smoking (29.6%), cigarette smoking (27.8%) and chewing betel quid with tobacco/zarda (17.5%) were predominant. Overall prevalence of illicit drug use was 4%. Ganja was the main drug (3%), followed by phensidyl (0.8%), heroin (0.3%) and charas (0.3%). Age, education, place of residence, marital status, having STDs, premarital and extra-marital sex were associated significantly with tobacco smoking. Almost all variables were also associated significantly with illicit drug use. Smoking cigarettes and bidi and eating tobacco leaves/shada pata/gul showed significantly positive associations with illicit drug use when adjusted for other variables. CONCLUSIONS: Tobacco consumption is common and associated positively with the illicit drug use among males in Bangladesh.

Adolescent↗

Medical care for nursing home residents: differences by dementia status. Epidemiology of Dementia in Nursing Homes Research Group.

OBJECTIVE: To understand the use of medical services by nursing home residents. DESIGN: Descriptive, longitudinal study comparing medical service use of residents by dementia status and describing the use of medical services following detection of fever or infection. SETTING: Fifty-nine randomly selected nursing homes in Maryland from 1992 to 1995. PARTICIPANTS: 2,153 residents admitted to one of 59 randomly selected nursing homes. MEASUREMENT: A panel of psychiatrists and neurologists ascertained dementia based on review of medical records, interview data with significant others and nursing staff, and results of a cognitive exam. Medical service use was abstracted from medical records. BACKGROUND: Understanding the use of medical services by nursing home residents as distinct from services provided by the nursing home is important, particularly as new medical care models are tested. This study compares the medical service use of residents by dementia status and describes the use of medical services following detection of fever or infection. RESULTS: Residents with dementia compared with those without dementia had lower annual rates of physician visits (10.2 vs 12.7, P < .001) and hospitalizations (0.9 vs 1.2, P < .001), virtually the same rate of emergency department visits, and similar lengths of stay in the hospital. Subsequent to infection, a lower proportion of residents with dementia had either a physician visit, an emergency department visit, or a hospital admission compared with residents without dementia (27.2% vs 32.2%, P < .001). In 87% of infections, an antibiotic was used, implying meaningful contact with a physician. Residents with dementia compared with those without dementia had fewer physician visits subsequent to fevers (20.6% vs 29.9%, P < .001) and infections (21.8% vs 27.5%, P < .001). CONCLUSIONS: The association of less medical service use by individuals with dementia compared with those without dementia may reflect differences in health status or implicit end-of-life decision-making and a proclivity toward less-aggressive treatment for these individuals.

Aged↗

CDC-funded intervention research aimed at promoting colorectal cancer screening in communities.

BACKGROUND: Although strong scientific evidence has shown that screening for colorectal cancer saves lives, most U.S. adults who are at the recommended age are not being screened. Prior studies suggest that barriers to routine screening vary by race, ethnicity, socioeconomic status, urban/rural residence, health insurance status, and factors related to health care providers and the health care environment. Relatively few studies, however, have identified and tested intervention approaches to promote routine colorectal cancer screening among diverse populations. METHODS: The Division of Cancer Prevention and Control at CDC has funded ongoing projects to develop and test interventions to promote routine colorectal cancer screening among medically underserved populations in Appalachia, the Lower Rio Grande Valley in Texas, the High Plains region of Colorado, and other U.S. communities. RESULTS: This article provides an overview of colorectal cancer screening intervention studies currently funded by CDC that focus on a wide range of populations, including medically underserved persons who live in predominately rural areas, Hispanic and non-Hispanic persons, urban African Americans, persons with low health literacy, and persons enrolled in managed care organizations. CONCLUSIONS: These CDC-funded intervention research projects are likely to contribute importantly to evidence about what works to promote colorectal cancer screening in diverse U.S. communities. .

Black or African American↗

The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program.

PURPOSE: To study the relationship of physical activity and obesity with all-cause mortality in Puerto Rican Men. METHODS: The Puerto Rico Heart Health Program collected physical activity and anthropometric measurements in 9,824 men between 1962 and 1965. After excluding those with known coronary heart disease at baseline, and those who died within the first three years of the study we analyzed the data for the relationship between physical activity and overweight status to all-cause mortality in 9,136 men. We stratified our participants by quartiles of physical activity. Participants were classified into four categories of body weight: underweight (BMI < 18.5), healthy weight (BMI =18.5-24.9), overweight (BMI = 25-29.9), and obese (BMI = 30+). RESULTS: After adjusting for age, education, smoking status, hypertension status, hypercholesterolemic status, urban/rural residence, and overweight status, physical activity was independently related to all-cause mortality. All-cause mortality was lower in those in quartile 2 (OR = 0.68, CI = 0.58-0.79) than quartile 1 (reference, sedentary group). Mortality among those in quartile 3 and 4 (0.63, CI = 0.54-0.75; and 0.55, CI = 0.46-0.65, respectively) were also significantly lower than those observed in quartile 1, but not significantly lower than those observed in quartile 2. Furthermore, within every category of body weight, those who were most active had significantly lower odds ratio of all-cause mortality. CONCLUSION: Our findings support the current recommendation that some physical activity is better than none, in protecting against all-cause mortality. The benefits of an active lifestyle are independent of body weight and that overweight and obese Puerto Rican men who are physically active experienced significant reductions in all-cause mortality compared with their sedentary counterparts.

Body Mass Index↗

A national survey of hypnosis training--its status in psychiatric residency programs: a brief communication.

Hypnosis training in psychiatric residency programs has not previously been well documented in the literature. This article examines the extent of such training in residency programs and the attitudes of residency directors to training and the use of hypnosis. A brief survey requesting information on hypnosis training was sent to all psychiatric residency directors in the United States. Sixty-three percent of responding program directors (n = 154) report offering either required or elective coursework in hypnosis. Of programs offering hypnosis training, the mean number of hours was 8, suggesting that many psychiatrists have only limited exposure to hypnosis during residency. The authors conclude that hypnosis training is widely variable within psychiatric residency programs and is dependent on the faculty and training director interests within individual programs.

Attitude of Health Personnel↗

Nutritional status of elderly residents in Missouri.

Nutritional assessment of white persons over 59 who participated in the 1973 Missouri Nutrition Survey was based upon biochemical measurements, dietary intakes using food frequency histories, anthropometric measurements, and a dental examination. There were three major nutritionally related problems: poor dental health, obesity, and anemia. The mean for DMF, periodental index, and oral hygiene index for males was 20.5, 4.9, and 3.9, respectively; for females, 17.6, 3.6, and 2.5. Over one-half of both sexes were edentulous. Of the women 59% were greater than 119% of desirable weight compared to 22% of the men. Using guidelines from the Ten-State Nutrition Survey, the following percentages of men had low blood levels: 20, hemoglobin and serum iron; 2, plasma vitamin A; 6, plasma carotene; 1, serum vitamin C; and 0, serum albumin. The percent of women with low biochemical levels were: 11, hemoglobin; 10, serum iron; 7, plasma vitamin A; 1, serum vitamin C; and 2, serum albumin. None of the subjects had low or deficient levels of erythrocyte glutathione reductase. One-half of the women compared to one-fifth of the men had consumed diets with one or more nutrients below 67% of the 1974 Recommended Dietary Allowances.

Aged↗

Foreign migrant workers in Japan: trends and policies.

"This research note presents data on trends in foreign workers in Japan, and reviews recent policy changes relating to these workers. Trends from 1973-1993 are reviewed and data for recent years include disaggregation by country of origin, residence within Japan, status of residence, illegal workers, and gender."

Asia↗