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PubMed2005

The health status of HOPE VI public housing residents.

The purpose of this study is to provide new data on the relationship between housing quality and health status for people in five HOPE VI public housing developments around the country. HOPE VI is a federal program to replace or redevelop some of the poorest quality public housing in the country. A special survey of residents of these developments was conducted while they lived in HOPE VI housing before its redevelopment. Data for these individuals provides a profile of the quality of housing and the health status of people in HOPE VI housing before its renovation, of residents of publicly assisted housing across the nation, of other people living below the federal poverty level, and of non-poor people. Previously, the lack of data sets that included both housing quality and health status measures has prevented such an analysis. We examined two indicators of health status-perceived overall health status and medically diagnosed asthma. The health status of HOPE VI residents is decidedly worse than that of others in assisted housing and other poor people, despite their similarity in terms of economic deprivation. The difference in the level of asthma prevalence, a condition that has been tied to various measures of housing quality, is especially pronounced. Our analysis indicates that one major benefit of improving housing quality may be improved health status.

Adolescent↗
PubMed2002

Summary health statistics for U.S. adults: National Health Interview Survey, 1997.

This report presents health statistics from the 1997 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, region of residence, and where appropriate, education, income, health insurance coverage, marital status, and place of residence. The topics covered are health status and limitations in activity, health care access and utilization, health behaviors and lifestyle, chronic condition prevalence, and knowledge and attitudes toward the Acquired Immunodeficiency Syndrome (AIDS). Source of Data The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews. Highlights Among adults 18 years of age or over, 12% had ever been told by a doctor or health professional that they had heart disease, 6% had ever been told they had coronary heart disease, and 19% had been told on two visits or more that they had hypertension. Nearly a quarter of adults were current smokers, 23% were former smokers, and 52% had never smoked. Sixty-one percent did not engage in any leisure-time vigorous physical activity, while approximately 24% engaged in such activity three times or more per week. Based on estimates of body mass index, 4% of adults were underweight, 42% were at a healthy weight, 35% were overweight, and 19% were obese.

Adolescent↗
PubMed1994

Comments on a process for identifying stages of dementia in residents of nursing facilities.

This paper gives a description of how items of the Global Deterioration Scale's Brief Cognitive Rating Scale and Functional Assessment Staging can be verified by reviewing specific sections and items of the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening which is completed annually and updated every three months or when significant changes in health occur. A likely outcome of such comparison is improved understanding of the cognitive and functional status of residents with dementia and other medical conditions.

Aged↗
PubMed2006

Differences between newly admitted nursing home residents in rural and nonrural areas in a national sample.

PURPOSE: Previous research in specific locales indicates that individuals admitted to rural nursing homes have lower care needs than individuals admitted to nursing homes in urban areas, and that rural nursing homes differ in their mix of short-stay and chronic-care residents. This research investigates whether differences in acuity are a function of differences in resident payer status and occur for both individuals admitted for short stays, with Medicare as payer, and those needing chronic care. DESIGN AND METHODS: We used a representative 10% sample of national resident assessments (Minimum Data Set) for calendar year 2000 (N = 197,589). We conducted statistical analyses (means, percentages, and logistic regression) to investigate differences in Medicare and non-Medicare admissions to facilities in metropolitan and nonmetropolitan areas. RESULTS: Non-Medicare residents admitted to rural nursing facilities have lower acuity scores than non-Medicare residents admitted to metropolitan nursing homes. However, individuals admitted under Medicare were similar in rural and urban areas. IMPLICATIONS: Differences in resident acuity at admission among facilities in different locales were largely a function of lower acuity levels for individuals admitted to rural nursing homes for long-term or chronic care, although differences in Medicare census also played some role in facility-level differences in acuity. Other factors must be explored to determine why this lower acuity occurs and whether higher use of rural nursing homes by less impaired older persons meets their needs and preferences and represents good public policy.

Adolescent↗
PubMed2004

Race/ethnicity and untreated dental caries: the impact of material and behavioral factors.

OBJECTIVE: To use nationally representative data, group variables into categories of material and behavioral factors, and assess their relative contribution to racial/ethnic variation in untreated caries. METHODS: Participants were from the Third National Health and Nutrition Examination Survey (NHANES III), aged 20-50 years. Material factors were income, education, employment status, dental insurance status, and urban residence. Behavioral factors were marital status, tobacco use, alcohol use, obesity, and social support. All models were additionally adjusted for age, gender, and quartile of missing teeth. The outcome was three or more carious teeth. RESULTS: Non-Hispanic blacks and Mexican-Americans displayed excess risk of untreated caries compared with non-Hispanic whites when adjusted for age, sex, and missing teeth (adjusted odds ratios 1.73 and 1.69, respectively). The addition of behavioral factors to this model resulted in virtually no changes in the adjusted odds ratios for race/ethnicity and untreated caries. When material factors were added to the basic model the excess risk for untreated caries among non-Hispanic blacks was reduced by approximately 21% and that of Mexican-Americans was no longer statistically significant compared with non-Hispanic whites (adjusted odds ratios 1.36 and 0.83, respectively). CONCLUSIONS: Much of the excess risk for untreated dental caries among non-Hispanic blacks and Mexican-Americans compared with non-Hispanic whites was eliminated when material factors were controlled, while no risk reductions were observed when behavioral factors were controlled. Addressing material factors may provide greater reductions in untreated caries disparities than behavioral interventions, and these risk reductions may vary with racial/ethnic group.

Adult↗
PubMed2003

Trends in surgery and chemotherapy for women diagnosed with ovarian cancer in the United States.

PURPOSE: We examined patterns of care in a population-based sample of 601 ovarian cancer patients diagnosed in 1991, and a sample of 566 women was selected in 1996 to examine trends in care. PATIENTS AND METHODS: Patient cases were sampled from within the Surveillance, Epidemiology, and End Results program. Medical records were reabstracted, and treatment data were verified with the treating physician. RESULTS: Across these two time periods, the percentage of women with presumptive stage I, II, and IV disease who received lymph node dissection increased. However, a significant number still were not precisely staged. More than 65% of women with ovarian cancer were given cyclophosphamide in 1991 compared with about 14% in 1996. Paclitaxel increased from 1% to 62% during that time. After adjusting for age, race or ethnicity, registry, income, insurance status, Charlson score, residency training program, and marital status, women with early-stage disease were significantly more often given National Institutes of Health Consensus Development Conference guideline therapy in 1996 than in 1991. However, for women with stage III and IV disease, the use of guideline therapy did not significantly increase. Older women and minorities consistently received less guideline therapy, and the lack of private insurance was an impediment for both Hispanic and non-Hispanic black women. CONCLUSION: Despite guidelines presented by several organizations, significant numbers of women with ovarian cancer are not being provided with appropriate care. This is particularly true for older and minority women, especially those without private insurance. Educational strategies must be devised to increase the number of women receiving guideline therapy and decrease disparities across population groups.

Aged↗
PubMed2005

The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia.

OBJECTIVES: The aim of this study was to determine the: (1) prevalence of undernutrition as determined by the 'DETERMINE Your Nutritional Health Checklist' (NHC) and (2) factors independently associated with undernutrition among the older residents of these publicly funded shelter homes in Peninsular Malaysia. DESIGN: A total of 1081 elderly people (59%M) over the age of 60 y were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well-being. SETTING: Shelter homes, Peninsular Malaysia. RESULTS: In all, 41.4% (n = 447) were nourished (score <3), 32.1% (n = 347) at moderate risk (score between 3 and 5) and 26.6% (n = 287) were at high risk of undernutrition (score>5) according to the NHC. A large proportion of subjects were underweight with 14.3% of subjects recording a low body mass index (BMI) <18.5 kg/m2 and a further 18.2% recording a BMI between 18.5 and 20 kg/m2. The residential geriatric depression score (GDS-12R) (relative risk (RR) = 1.03 (95% confidence interval (CI) 1.01-1.05); P = 0.002) and the number of illnesses (RR = 1.14 (95% CI 1.07-1.21); P < 0.001) were found to be independently associated with nutritional risk (NHC score > or = 3). Using a BMI < 18.5 kg/m2 as an objective marker for nutritional risk, the NHC was shown to have a sensitivity of 66.4% (95% CI 58.0-74.2%), specificity of 42.7% (95% CI 39.3-46.1%), positive predictive value of 16.2% (95% CI 13.3-19.5%) and a negative predictive value of 88.4% (95% CI 84.9-91.4%). CONCLUSIONS: Many elderly people residing in publicly funded shelter homes in Malaysia may be at-risk of undernutrition, and were underweight. The NHC is better used as an awareness tool rather than as a screening tool.

Aged↗
PubMed2006

The incidence of methylphenidate use by Canadian children: what is the impact of socioeconomic status and urban or rural residence?

OBJECTIVE: To examine socioeconomic, demographic, and behavioural factors that influence the incidence of methylphenidate use among children aged 4 to 13 years. METHOD: A total of 11,316 children, aged 2 through 11 years, from Cycle 1 (1994-95) of the National Longitudinal Survey of Children and Youth were followed up 2 years later in Cycle 2 (1996-97). The outcome measure was methylphenidate use in Cycle 2. Individual-level explanatory variables included sex, age, socioeconomic status (SES), mother's age at birth of child, lone-parent family status, parental working status, and hyperactivity-impulsivity and inattention probabilities. Area-level explanatory variables included income and rural or urban residence. We used hierarchical linear modelling to examine individual- and area-level factors that predicted methylphenidate use. RESULTS: The strongest predictors of methylphenidate use were behavioural: children with high hyperactive-impulsive and (or) inattention behaviours in 1994, compared with children low on these behaviours, were 4.5 to 6 times more likely to use methylphenidate 2 years later. SES remained a significant predictor of the incidence of methylphenidate use, even when other significant predictors were held constant, with lower SES being associated with higher use. Area-level income also predicted methylphenidate use. CONCLUSION: Even when children with similar behavioural symptoms and demographic characteristics were compared, socioeconomic factors had a significant impact on incidence of methylphenidate use.

Adolescent↗
PubMed1989

Hospital visitor-companions as a source of controls for case-control studies in the Philippines.

Hospital visitor-companions are being used as a source of controls in an ongoing case-control study on breast cancer in the Philippines. As a tool for rapid epidemiologic assessment in obtaining research data for case-control studies, visitor-companions may serve as an alternative source of controls. To determine their generalizability and consistency, this proposed group was compared to neighbourhood controls and to hospital-patient controls. Hospital visitor-companions were comparable to neighbourhood controls in terms of cooperation in the interviews, height, weight, marital status, longest residence, education, cigarette smoking, alcohol intake, annual income, proportion with salaried jobs, ownership of house, land, and business, number of people living in the house, number of siblings, medical history, parity, menopausal status, breast feeding practices, and use of oral contraceptives. Neighbourhood controls however had longer interview durations than visitor-companion controls (p less than 0.05). Hospital-patient controls were less likely to breast feed, had lower alcohol intake, and had more exposure to chronic diseases and diagnostic x-ray than visitor-companion or neighbourhood controls (p less than 0.05). It was concluded that visitor-companions may usefully serve as an alternative source of controls for case-control studies when their limitations are taken into consideration during analysis.

Breast Neoplasms↗
PubMed1990

General practice residency training and the osteopathic profession: trends and issues for the 1990s.

With the 1989-1990 training year, the length of postinternship residency training in osteopathic general practice will increase from 1 to 2 years. The longer residency is expected to give trainees a more complete and more competitive education and to protect them against discrimination regarding hospital privileges. With this change comes the opportunity to evaluate the current status of residency training in the field and to use the data as the basis for making rational predictions and recommendations for the future of the specialty. The author considers the effect of curriculum changes on the operation of training residents in osteopathic general practice. He examines the structure of the new training program and discusses issues pertaining to osteopathic general practice.

Education, Medical↗
PubMed2003

Summary health statistics for U.S. adults: National Health Interview Survey, 1999.

OBJECTIVES: This report presents health statistics from the 1999 National Health Interview Survey (NHIS) for the civilian, noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and attitudes toward Acquired Immune Deficiency Syndrome (AIDS). Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward AIDS. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Data are collected during face-to-face interviews with adults present at the time of the interview. The self-reported health information for adults in this report was obtained from one randomly-selected adult per family. HIGHLIGHTS: In 1999, 65% of adults 18 years of age or over reported excellent or very good health. However, 17% of adults less than 65 years of age had no health insurance coverage, and 16% of adults did not have a usual place of medical care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease and 19% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, while 23% were former smokers. Sixty-one percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Adolescent↗
PubMed2004

Summary health statistics for U.S. adults: National Health Interview Survey, 2001.

OBJECTIVES: This report presents health statistics from the 2001 National Health Interview Survey for the civilian noninstitutionalized adult population classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and functional limitations, health care access and utilization, health behaviors, and human immunodeficiency virus (HIV) testing. Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward HIV. SOURCE OF DATA: The National Health Interview Survey is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics and is representative of the civilian noninstitutionalized U.S. population. Sociodemographic data are collected for everyone in the family during face-to-face interviews with adults present at the time of the interview. The health information for adults in this report was obtained from one randomly selected adult per family. HIGHLIGHTS: In 2001, 64% of adults 18 years of age and over reported excellent or very good health. Fifty-eight percent of adults never participated in any type of vigorous leisure-time physical activity, and 13% of adults did not have a usual place of health care. Twelve percent of adults had been told by a doctor or health professional that they had heart disease, and 21% had been told on two or more visits that they had hypertension. Nearly a quarter of all adults were current smokers, and 22% were former smokers. Based on estimates of body mass index, 36% of adults were overweight and 23% were obese.

Adolescent↗
PubMed2003

Summary health statistics for U.S. adults: National Health Interview Survey, 2000.

OBJECTIVES: This report presents health statistics from the 2000 National Health Interview Survey for the civilian noninstitutionalized adult population, classified by sex, age, race and Hispanic origin, poverty status, and region of residence for chronic condition prevalence, health status and limitations in activity, health care access and utilization, health behaviors, and human immunodeficiency virus (HIV) testing. Also, health statistics by education, income, health insurance coverage, marital status, and place of residence are presented for health status and limitations in activity, health care access and utilization, health behaviors, and knowledge and attitudes toward HIV. SOURCE OF DATA: The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the National Center for Health Statistics, Centers for Disease Control and Prevention, and is representative of the civilian noninstitutionalized U.S. population. Sociodemographic data are collected for everyone in the family during face-to-face interviews with adults present at the time of the interview. The health information for adults in this report was obtained from one randomly selected adult per family. HIGHLIGHTS: In 2000, 64% of adults 18 years of age and over reported excellent or very good health. Eighteen percent of adults under 65 years of age had no health insurance coverage, and 14% of adults did not have a usual place of health care. Eleven percent of adults had ever been told by a doctor or health professional that they had heart disease, and 20% had been told on two or more visits that they had hypertension. Nearly a quarter of adults were current smokers, and 22% were former smokers. Sixty percent did not engage in any leisure-time vigorous physical activity, and, based on estimates of body mass index, 35% were overweight and 21% were obese.

Activities of Daily Living↗
PubMed1993

Respiratory illness in persons with human immunodeficiency virus infection. The Pulmonary Complications of HIV Infection Study Group.

Although the pulmonary complications of advanced human immunodeficiency virus (HIV) infection have been well described, there is little information on respiratory manifestations of earlier disease. This report describes the respiratory disorders diagnosed over an 18-month period in a cohort of persons with or at risk for HIV infection with variable immunologic status. Cohort members were followed routinely and evaluated for respiratory disease by standard diagnostic algorithms. The 18-month incidence of each respiratory diagnosis was determined, and for frequent diagnoses, incidence by transmission category, location of residence, smoking status, CD4 count, and performance score at entry were compared. The most frequent respiratory diagnoses in HIV-seropositive cohort members were common to the general population: upper respiratory infection (33.4%), acute bronchitis (16.0%), acute sinusitis (5.3%), and bacterial pneumonia (4.8%). Pneumocystis carinii pneumonia occurred in 3.9%. Ambulatory respiratory illnesses were reported frequently regardless of immunologic status. The rates of P. carinii pneumonia and bacterial pneumonia were significantly greater in cohort members with entry CD4 counts < 250. Bacterial pneumonia occurred more frequently in injecting drug users and in cohort members with entry Karnofsky scores < 90. Disease stage and demographic and exposure factors are important variables affecting the respiratory manifestations of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2005

Community factors, hospital characteristics and inter-regional outcome variations following acute myocardial infarction in Canada.

BACKGROUND: While various community and hospital characteristics have been demonstrated to have an impact on individual cardiovascular outcomes, the extent to which such factors account for inter-regional and interhospital outcome variations following acute myocardial infarction (AMI) remains unknown. OBJECTIVES: To examine the impact of community and hospital factors on individual AMI outcomes and procedure use, and to determine the extent to which such characteristics account for inter-regional and interinstitutional AMI outcome and procedure variations across Canada. METHODS: Patients hospitalized with AMI between April 1, 1997, and March 31, 2000, across Canada were examined. The community and hospital characteristics studied included three indicators of socioeconomic status, two indicators of ethnicity, rural-urban status of residence, hospital academic affiliation, and the presence or absence of on-site angiography or revascularization capabilities at the admitting institution. Outcomes included in-hospital mortality, one-year cardiac readmissions and 30-day revascularization rates post-AMI. All analyses were adjusted for age, sex and age-sex interaction. The relationships between community/hospital factors and individual outcomes were examined using random-effects hierarchical logistic regression analysis, while the relationships between community/hospital characteristics and inter-regional/hospital risk-adjusted outcomes were examined using least squares regression and the coefficient of determination (r2). RESULTS: After adjusting for demographic factors, a patient's neighbourhood socioeconomic status was inversely correlated with the likelihood of death and downstream cardiac readmissions (P<0.001); patients residing in lower educated regions were less likely to receive revascularization post-AMI (P<0.001). Patients living in regions with higher concentrations of new immigrants and/or visible minorities, as well as those admitted to academically affiliated hospitals or hospitals with on-site procedural capacity, had fewer cardiac readmissions (P<0.001) and greater use of revascularization post-AMI (P<0.001) after adjusting for age and sex. Despite their associations with outcomes on an individual patient level, community and hospital factors explained no more than 7% of the variation in the risk-adjusted outcomes across hospitals or regions. Finally, adjustments for community and hospital factors and procedure use, beyond adjustments for age and sex alone, had marginal impact on a province's risk-adjusted outcomes. CONCLUSIONS: While community and hospital factors are important determinants of individual outcomes after AMI, they account for only a minimal degree of outcome variation across regions. Further studies are required to examine whether AMI outcome variations in Canada are explained by differences in patient clinical profiles and/or by differences in the decision-making behaviours of providers across jurisdictions.

Adult↗