A workshop for first-year residents on discussing "code status" in hospitals.
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Attitude of Health Personnel↗
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Functional and residential status transitions among nursing home residents.
BACKGROUND: The present study examines transitions in the functional status and discharge destination of new nursing home admissions who remain at least 100 days, and ascertains baseline covariates associated with transition patterns. METHODS: Using a fully observed, continuous-time Markov chain model for maximum likelihood estimation of probability intensities, transition processes are characterized. The long-stay cohort (n = 9,541) was derived from a sample of elders newly admitted to 48 National Health Corporation (NHC) nursing homes between 1983 and 1987. Assessment of functional status, using a modified Katz ADL scale, occurred during the first, second, and third months, and the second, third, and fourth quarters after admission. Four types of residential changes (e.g., mortality) were examined for the latter three quarters. RESULTS: While stability was the predominant pattern during the first 90 days in the nursing home, 51.5% of residents experienced a change in function. The probability of change was higher for modest (one level) rather than substantial change, and for such change to represent improvement rather than decline. Over 25% of this long-stay sample exited in the second quarter, 37% of them returning home. The rates for returns to home and for mortality were strongly related to functional level. Several sociodemography variables (e.g., age, source of payment), diagnostic indicators (e.g., cancer), and orientation status were consistently associated with transition rates within functionally homogeneous groups. CONCLUSIONS: Overall, findings underscore the heterogeneity and complexity of transition patterns for a subgroup historically treated as likely to decline or remain stable, and viewed as "permanent" residents. The model was useful in describing the volatile transition process among older long-stayers.
Activities of Daily Living↗
Longitudinal study of asymptomatic meningococcal carriage in two Belgian populations of schoolchildren.
In Brussels, a 15-month longitudinal survey was conducted in two primary schools, from March 1975 to May 1976, in order to analyse the dynamic of asymptomatic meningococcal carriage, during an epidemic mainly caused by serogroup B, serotype 2 Neisseria meningitidis. In the first school, which is situated in a suburban area with upper-middle socio-economic status of residents, a mean prevalence of carriers of 10 per cent, an acquisition rate of eight per 1000 months, and a mean duration of carriage of 12.4 months were observed among 158 schoolchildren aged six to 11 years old. In the second school, which is situated in a densely populated area with low socio-economic status of residents, a mean prevalence of carriers of 33 per cent, an acquisition rate of 28 per 1000 months, and a mean duration of carriage of 11.7 months were observed among 203 schoolchildren aged three to 14 years old. For both schools, the median duration of carriage was estimated at 9.4 months. The differences of prevalence and incidence of acquisition between the two schools cannot be explained by age, sex or ethnic factors and are probably related to socio familial variables. The theoretical relationship between prevalence, incidence and duration of meningococcal carriage was for the first time demonstrated in this study. The results also suggest that populations of low socio-economic status and living in densely populated areas constitute a target population for meningococcal disease prevention.
Adolescent↗
[Depression, health status and lifestyles of residents of a rural community].
A survey was conducted to examine the prevalence of depressive symptomatology among residents of a rural community using the Center for Epidemiologic Studies Depression (CES-D) Scale. Subjects were 220 men and 319 women aged between 30 and 69 who participated in annual community health examinations. The relation of depressive symptomatology to the results of physical examination, self-rated health status, subjective symptoms and lifestyles were also examined. The results are as follows. 1) Of the subjects, 13.2% of the men and 16.3% of the women had depressive symptomatology (CES-D score > or = 16), with 4.5% of the men and 9.4% of the women having moderate or severe depressive symptomatology (CES-D score > or = 20). Prevalence was higher for younger men and for women in their forties, but these differences were not statistically significant. 2) There was a weak correlation between depressive symptomatology and the results of physical examination. Self-rated health status was more significantly correlated with depressive symptomatology. Self-rated health status and depressive symptomatology each correlated independently with the number of symptoms experienced by the subjects over the past year. The subjective symptoms that were correlated with depressive symptomatology were different from those correlated to self-rated health status. Men and women also had differences in links between depressive symptomatology, self-rated health status and symptoms experienced. 3) Lifestyles of those who had depressive symptomatology were worse than those who did not. But only duration of sleep and food intake had statistically significant relation to depressive symptomatology. Only weak correlations between lifestyles and self-rated health status were observed.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Nutrition and health status assessment of community-residing elderly in New York City: a pilot study.
Ninety-five percent of persons over the age of 65 years live in the community and benefit from community-based health and nutrition services. The purpose of this project was to evaluate diet, function, and mental health in 40 men and women aged 65 years and older who were residing in a large metropolitan community. Nutritional status was assessed using two 24-hour recalls, 5 days of food records, a food frequency, and anthropometric measurements. Participants responded to standardized activities of daily living and instrumental activities of daily living instruments and an investigator-developed, performance-based appraisal of food preparation and management. Cognition and mood were assessed using the Folstein Mini-Mental Examination and the Yesavage Depression Scale. The nutrient intakes for individuals were compared with the Recommended Dietary Allowances (RDAs) and the Food Guide Pyramid. Mean energy intake was 1,625 kcal (range = 787 to 2,910 kcal); 7 persons consumed more than 2,000 kcal. The mean vitamin and mineral intake for participants met the RDAs except for calcium, vitamin D, zinc, and magnesium intakes. The average percentages of carbohydrate, protein, and fat were 53%, 16%, and 30%, respectively. Nutritional assessments of subjects with and without congregate meals were contrasted. Six of the 13 congregate-meal participants were at nutritional risk, compared with 6 of 27 not receiving congregate meals. The interrelationships of diet, functional status, and mental health factors were examined along with recommendations for future data collection in similar studies.
Aged↗
Duty hours and pregnancy outcome among residents in obstetrics and gynecology.
OBJECTIVE: To assess the present status of resident duty hours in obstetrics and gynecology, identify existing policies concerning work schedules during pregnancy, and evaluate pregnancy outcome in female house officers. METHODS: A questionnaire-based study was administered to residents taking the 2001 Council on Residency Education in Obstetrics and Gynecology examination. RESULTS: More than 90% of the residents reported that their institution had a maternity leave policy. The leave was usually 4-8 weeks long and was paid. Nearly 95% of residents reported that they had to take over the work of residents on maternity leave. Most women residents worked more than 80 hours weekly throughout pregnancy, and few took time off before delivery. Most pregnancies occurred during the fourth year of training and did not seem to be adversely affected by the long work hours. CONCLUSION: This study, performed before the institution of the new Accreditation Council for Graduate Medical Education resident duty hour policies, demonstrated that, although women house officers continued to work more than 80 hours per week during pregnancy, most had a good pregnancy outcome. Nevertheless, there was a higher frequency of preterm labor, preeclampsia, and fetal growth restriction in female residents than in spouses or partners of male residents.
Adult↗
Neuropsychological function and psychosocial status of alcohol rehabilitation program residents.
This investigation examined the relationship between changes in psychosocial status and changes in neuropsychological function of clients undergoing treatment for substance use. A sample of 74 adults enrolled at a rehabilitation program for substance use were randomly assigned to two groups (one serving as a comparison group for practice effects). Participants were tested three times over 60 days on self-esteem, motivation, depression, and neuropsychological function. Consistent with other studies, participants demonstrated impaired baseline neuropsychological function that improved with alcoholic abstinence; however, changes in motivation and depression were associated with positive changes on few tests of neuropsychological function. The more common predictor of improved motor function test scores was low baseline function. Participants who remained in treatment were more likely to be Black, homeless, report less alcohol consumption, and score lower on a motivational scale than those who left treatment.
Adult↗
Vulnerable populations at risk of potentially avoidable hospitalizations: the case of nursing home residents with Alzheimer's disease.
This study explores whether nursing home residents with Alzheimer's disease and related dementias (ADRD) are affected differently by facility-level risk factors of ambulatory care-sensitive (ACS) conditions, a measure of timely access to medical care. Three years of quarterly Medicaid reimbursement data from over 525 Massachusetts nursing homes were linked with four years of Medical Provider Analysis and Review hospital claims data and facility-level attribute data to investigate whether facility effects differed by resident ADRD status. The findings suggest that nursing home residents with ADRD are more likely to be hospitalized for certain ACS conditions, including gastroenteritis and kidney/ urinary tract infections. Availability of increased registered nurse staffing levels and on-site nurse practitioners appears to attenuate this risk. Although findings suggest that ACS hospitalization measures may represent a useful approach to monitoring nursing home care, additional effort is needed to understand the extent to which severity of illness and/or comorbidities affect the measurement of these hospitalizations.
Accidents↗
[Evaluation of antenatal peregrination in a sample of postpartum women in Rio de Janeiro, Brazil, 1999/2001].
The access to obstetric care in the city of Rio de Janeiro, Brazil, was evaluated in this study. The aim of this article was to determine the social, demographic and obstetric factors associated with the antenatal search for health services, in a sample of 6,652 postpartum women. It was observed that 1/3 of patients have to search for services in more than one hospital, not uncommonly in 3 or more. It is important to consider that only 1/5 of these patients are transferred by ambulance. The factors associated with this peregrination were: place of residence, birth weight, age, skin color, marital status and residence in places where garbage is not picked up. There was no association with schooling; Kotelchuck modified index, obstetric risk, water source and residence in slums.
Adolescent↗
Young disabled residents in old people's homes.
A survey of the status of residents in aged care facilities in the Auckland region conducted in 1988 indicated that almost 9% (645) of the 7516 people studied were under 65 years of age. Rates were markedly higher for people of Maori descent than for those of European descent in this age group. For nonMaori, the rate for men was higher than that for women, but for Maori the opposite was the case. The majority of these young residents (94%) were being cared for in commercial old people's homes. One half were cared for in just 29 of the 223 homes in the region. While most (59%) were admitted after the age of 50, 15% were admitted before they were 40 and must expect to liver their lives out in institutions primarily housing elderly residents. Almost half of those in old people's homes had been admitted from a psychiatric hospital. The authors are concerned that so many young people appear to be in old people's homes because of a lack of alternative accommodation which is more suited to their care.
Activities of Daily Living↗
Prevalence and reporting of induced abortion in Turkey: two survey techniques.
This study was designed and conducted to test the relative reliability of reported induced abortion obtained through a conventional survey technique (direct questioning) as compared with an estimated proportion of women with induced abortion obtained through the randomized response technique. Two independent, nationally representative samples were used, one for each approach. A total of 1,521 women were interviewed in the direct question sample, providing a 70.1 percent response rate. In the randomized response sample, 1,674 women participated in the study, representing a 72.9 percent response rate; 1,044 or 62.4 percent of these women provided usable answers. There were substantial differentials in the successful use among the subcategories of independent variables. Of the 1,044 women in the RRT sample, 33.1 percent were estimated to have had at least one induced abortion during their reproductive lives--a much higher rate than the 13.9 percent obtained from the DQ sample. The factors found to be of relevance in relation to induced abortion including age, education, place of residence, development status of the province where the woman resided, number of pregnancies and living children, occupation, and family type.
Abortion, Illegal↗
Impact of a buffet-style dining program on weight and biochemical indicators of nutritional status in nursing home residents: a pilot study.
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Aged↗
Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?
OBJECTIVE: To test the hypothesis that as a minority with lower socio-economic status, Turkish residents in Germany might experience a higher mortality than Germans. METHODS: All-cause mortality rates by age group and sex of Turkish and German adults for the time period 1980-94 were calculated from death registry data and mid-year population estimates. RESULTS: The age-adjusted mortality rate (per 100000) of Turkish males aged 25-65 years resident in Germany was 299 in 1980 and 247 in 1990, consistently half that of German males. The mortality of Turkish females in Germany was 140 in 1990, half that of German females. Mortality of Turkish males/females in Ankara was 835 and 426 in 1990. CONCLUSION: In view of the socio-economic status of Turkish residents in Germany the large mortality difference compared to Germans is unexpected. It cannot be fully explained by a selection at the time of hiring (healthy migrant effect) because it lasts over decades and extends into the second generation. A healthy worker effect is unlikely because Turkish residents have a lower employment rate than Germans. There is little evidence for movement of gravely ill persons back to Turkey. An 'unhealthy re-migration effect' in which socially successful migrants with a lower mortality risk stay in the host country while less successful ones return home even before becoming manifestly ill would partly explain our findings.
Adult↗
Risk factors for infection in women undergoing testing for Chlamydia trachomatis and Neisseria gonorrhoeae in Manitoba, Canada.
BACKGROUND AND OBJECTIVES: Despite sharing common modes of transmission, characteristics of individuals infected with Chlamydia trachomatis differ in several respects from those with Neisseria gonorrhoeae infection. Further characterization of women at high risk for chlamydial infection is needed to deliver appropriate and effective preventive, diagnostic, and therapeutic care to this population. GOAL OF THIS STUDY: The demographic and socioeconomic characteristics of women with laboratory confirmed chlamydia, gonorrhea, or coinfection were compared with those of control women who tested negative for both pathogens. STUDY DESIGN: A random sample of 400 women in Manitoba, Canada, who had undergone testing for sexually transmitted diseases at a public health laboratory in 1988 were studied. After linkage with medical insurance and census databases, logistic regression analysis was used to compare age, ethnicity, urban status, and mean income (using postal codes) of women with gonorrhea alone, chlamydia alone, and coinfection, with the same data for women who tested negative for both organisms. RESULTS: Young age, North American Indian status, urban residence, and low mean income according to postal code were significantly associated with gonococcal and chlamydial infection in the study population, compared with women who tested negative for both infections. Young age, Indian status, and urban residence also were associated with gonorrhea infection alone. Only young age and Indian status were associated with chlamydial infection. Mean incomes of women with chlamydial infection alone and control subjects were higher than those of women with gonorrhea and gonorrhea and chlamydia coinfection. CONCLUSIONS: Differences in the demographic and socioeconomic characteristics of women with gonorrhea, chlamydia, and coinfection suggest the existence of multiple reservoirs of infection due to these agents in the study population. The preventive, diagnostic, and therapeutic strategies of sexually transmitted disease control programs must be adapted to the individual needs of identified high-risk groups.
Adolescent↗
Stability and improvement of health after nursing home admission.
This prospective study investigated stability of residents' mental status, function (activities of daily living), and mood during the first and second week following nursing home admission. New residents (N = 647) in eight urban nursing homes were assessed three times. Mental status was measured using the Short Portable Mental Status Questionnaire, function was measured using Scaled Outcome Criteria, and mood was measured using the Mood Adjective Checklist. A repeated measures multivariate analysis of variance, controlling for admission from hospital and readmission to the nursing home, documented stable mental status during the first and second week of nursing home residence. Hygiene, grooming, dressing, and transferring improved, whereas feeding, ambulation, urination, and defecation were stable. Tired and depressed mood adjectives improved, and angry, cheerful, afraid, lonely, and alert mood adjectives were stable. Residents admitted from a hospital had lower mental status and function scores, and readmitted residents had lower urination scores.
Activities of Daily Living↗
Does living in an urban environment confer advantages for childhood nutritional status? Analysis of disparities in nutritional status by wealth and residence in Angola, Central African Republic and Senegal.
OBJECTIVE: The purpose of this paper is to examine the relationship between childhood undernutrition and poverty in urban and rural areas. DESIGN: Anthropometric and socio-economic data from Multiple Indicator Cluster Surveys in Angola-Secured Territory (Angola ST), Central African Republic and Senegal were used in this analysis. The population considered in this study is children 0-59 months, whose records include complete anthropometric data on height, weight, age, gender, socio-economic level and urban or rural area of residence. In addition to simple urban/rural comparisons, the population was stratified using a wealth index based on living conditions and asset ownership to compare the prevalence, mean Z-score and odds ratios for stunting and wasting. RESULTS: In all cases, when using a simple urban/rural comparison, the prevalence of stunting was significantly higher in rural areas. However, when the urban and rural populations were stratified using a measure of wealth, the differences in prevalence of stunting and underweight in urban and rural areas of Angola ST, Central African Republic and Senegal disappeared. Poor children in these urban areas were just as likely to be stunted or underweight as poor children living in rural areas. The odds ratio of stunting in the poorest compared with the richest quintile was 3.4, 3.2 and 1.5 in Angola ST, Senegal and Central African Republic, respectively. CONCLUSIONS: This paper demonstrates that simple urban/rural comparisons mask wide disparities in subgroups according to wealth. There is a strong relationship between poverty and chronic undernutrition in both urban and rural areas; this relationship does not change simply by living in an urban environment. However, urban and rural living conditions and lifestyles differ, and it is important to consider these differences when designing programmes and policies to address undernutrition.
Angola↗
Adolescents' psychological response to the experience of community interpersonal violence: a cross-national and a cross-cultural comparison.
A comparative cross-national study investigating the level of experience with community interpersonal violence, level of psychological distress, and the relationship between exposure and distress among adolescents is presented. Participants were 617 first-year college students comprising African Americans and Jamaican Americans living in New York City, and Jamaicans living in Kingston, Jamaica. The three groups are similar in terms of age, gender, educational level, and race; they differ in location of residence, culture, and immigration status. Location of residence is related to exposure; immigration status is related to distress; but culture is not related to vulnerability when exposed. The effect size of the relationship between exposure and distress appears to be robust across variations in culture, amount of exposure, and level of distress.
Acculturation↗
Preparing residents for Public Law 99-457. A survey of pediatric training programs.
Recent implementation of Public Law 99-457 has high-lighted the integral role of pediatricians in early intervention for infants and young children (birth to age 3 years) with disabilities and their families. Faculty representatives of all US pediatric residency programs were surveyed to determine the current status of resident education about issues in this content area. Of 219 surveys, 159 (73%) were returned and analyzed. Resident rotations in child development were offered in 89% of the programs. Of these, 73% were mandatory rotations. Generally, comprehensive resident exposure to a majority of important topics regarding Public Law 99-457 was reported. However, minimal teaching by parents and community agencies was used. Content areas perceived to be strengths in most programs included normal and atypical infant development and developmental assessment. Weaker areas included cultural aspects of family function, case management, and advocacy. Barriers to optimal teaching included time constraints of residents and faculty, inadequate resources and facilities, and insufficient resident interest. Respondents expressed strong interest in improving resident education in this area.
Child Development↗