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[Compliance and efficacy of standard antenatal care model].

OBJECTIVE: To investigate the compliance of standard antenatal care (ANC) model with 12-13 visits currently used in Beijing region, and to assess the efficacy of this model in reducing adverse maternal and perinatal complication. METHODS: The clinical data of 544 women who delivered at Peking Union Medical College Hospital (West Section) from January 1, 1999 to December 31, 2002 were retrospectively reviewed and analyzed. Three areas were addressed in this paper: compliance of pregnant women with standard ANC model; association of maternal and perinatal complication with different number of ANC visits; effectiveness of screening for risk factors at the first ANC visit. RESULTS: A median of 8 ANC visits was made in 544 cases, of whom 22 cases (4.0%) never had ANC visit before delivery. The women were divided into three groups according to the status of residence and education levels: temporary residents in Beijing city (group A), permanent residents with middle or low education level (group B), and permanent residents with high education level (group C). The average number of ANC visits in group A was 4.55 +/- 3.1, which was much lower than in group B (8.71 +/- 2.2) and in group C (9.56 +/- 2.1) (P < 0.001). The mean duration of gestation at the first ANC visit in group A was (25.44 +/- 8.8) weeks much longer than (15.58 +/- 5.8) weeks in group B and (14.24 +/- 3.2) weeks in group C (P < 0.001). Among 544 cases, 93 (17.1%) had ANC visit for 0-3 times, 299 (55.0%) for 4-9 times and 152 (27.9%) for > or = 10 times. There was no statistical difference among varied number of ANC visits when the results were pooled for pregnancy induced hypertension, gestational diabetes mellitus, vaginal bleeding at the second and third trimesters, postpartum hemorrhage, fetal macrosomia, premature rupture of membrane, and fetal distress (P > 0.05). An increase in the number of ANC visits was associated with the decreased rates of fetal growth restriction (P < 0.05) and premature delivery (P < 0.05), whereas it was paralleled with increased rates of anemia and cesarean section (P < 0.001). It was found that 35.6% of women who developed maternal and perinatal complications would be identified through screening for risk factors at the first ANC visit. CONCLUSIONS: Standard ANC model is currently not well complied. It has limited efficacy in reducing most maternal and perinatal complications. A more practical and effective ANC model for low educated women and temporary residents needs to be explored.

Adolescent↗

Monitoring ophthalmology graduate education. The Residency Review Committee.

Formal monitoring of quality control in American graduate medical education is the task of the residency review committees (RRCs). The RRC for ophthalmology consists of nine members appointed by the American Board of Ophthalmology, the American Academy of Ophthalmology, and the American Medical Association. The RRC meets twice each year to determine the accreditation status of residency training programs. As of 1978, the residents ae board eligible only if they have graduated from accredited programs. The review process is based on data collected in standard hospital information forms and a site survey. An RRC member evaluates this information and makes a recommendation that is discussed and voted on by the nine-member RRC body. In response to pressures for greater quality control and regulatory visibility, the review process has been bolstered by improvements in the data-gathering forms and in the surveyors and by a revision of the minimum requirements for accreditation that provides clearer and more stringent guidelines.

Accreditation↗

[Determining fertility behavior using path analysis].

In order to examine factors influencing the perception of ideal family size in Poland, "the present paper discusses path models, which explain a central reproductive behaviour category i.e. the actual number of children....[The author finds that] the image of the ideal family size directly influences the existing number of children. Path coefficients show that the increase of the ideal number of children by one standard deviation is associated with the increase of actual family size by approximately one third standard deviation of this explanatory variable." Other variables considered include parental influence, rural or urban residence, educational status, age at marriage, religion, and quality of life. (SUMMARY IN ENG)

Behavior↗

Nutritional status, well-being and functional ability in frail elderly service flat residents.

OBJECTIVE: To investigate nutritional status and its relationship to cognition, well-being, functional ability and energy intake in frail elderly service flat residents. DESIGN: Cross-sectional and prospective study. SETTING: Two municipal service flat complexes. SUBJECTS: A total of 80 residents (median age 85.5 (79-90) y) with regular home care assistance participated. A subgroup of 35 residents took part in a re-examination 1 y later. METHODS: Mini Nutritional Assessment (MNA), Short Portable Mental Status Questionnaire, Barthel Index and Health Index were used for the evaluation of nutritional, cognitive and ADL function and well-being, respectively. RESULTS: In all, 30% of the frail and chronically ill service flat residents were assessed as malnourished and 59% were at risk of malnutrition. The malnourished residents had worse cognitive conditions (P<0.001) and well-being (P<0.05), lower functional ability (P<0.01) and they had a greater need for daily assistance (P<0.05) than the other residents. The median night fast period was 14.0 (12.5-15.0) h. Five subjects classified as malnourished at baseline had lost a median of -9.6 kg (range -11.0 to +7.3 kg) (P<0.05) in body weight at the 1-y follow-up, which contrasted significantly from the weight stability in residents classified as at risk for malnutrition or well-nourished. CONCLUSION: Out of 10 residents, nine were assessed to have impending nutritional problems that related to impaired well-being, cognition, and functional ability. Malnourished residents had a significant weight loss over one year. Studies are needed to determine whether weight loss and nutrition-related dysfunction in service flat residents are preventable or treatable.

Activities of Daily Living↗

Energy density, energy intake and weight status in a large free-living sample of Chinese adults: exploring the underlying roles of fat, protein, carbohydrate, fiber and water intakes.

OBJECTIVE: This paper uses observational data to explore what dietary constituents might be responsible for associations between energy density, energy intake and weight status among free-living individuals. DESIGN: Cross-sectional data on 5783 Chinese adults (aged 20-59 y) from the 1991 China Health and Nutrition Surveys were used to test for associations between energy density, energy intake and weight status, controlling for age, sex, height, activity level, smoking status, urban residence and income. Pearson correlation coefficients were calculated to identify nutrient intake correlates of energy density. Replacing energy density with its nutrient correlates (3 day mean estimates of fat, protein, fiber and water intakes) in the models predicting energy intake and overweight status, the independent effects of specific nutrients were investigated. RESULTS: Energy density was positively and significantly associated with energy intake and overweight status. Energy density was significantly correlated with every nutrient examined, although the correlations were weak for most variables except water intake. Only water intake behaved consistently across analyses. It was negatively correlated with energy density, negatively, significantly and independently associated with energy intake as well as overweight status. Despite positive associations with energy intake, fat and protein intake were not significant predictors of overweight status. Fiber intake was strongly and positively associated with overweight status. CONCLUSIONS: Of the nutrients examined, only water intake appeared to explain the effects of energy density on energy intake and overweight status.

Adult↗

The influence of alcohol abuse as a hidden contributor to mortality.

Although only about 2-3 percent of annual deaths are attributed to one of the four underlying causes linked to chronic alcohol use, research results suggest that the impact of alcohol is much greater. The recent issue of mortality multiple cause of death tapes from National Center for Health Statistics permit exploration of associations of chronic alcohol abuse with conditions coded as underlying cause of death and provide leads for case-finding. Data analysis is reported from certificates of resident deaths in the United States in 1978. There are 12 groups of underlying causes for which the percentage of pairings with chronic alcohol abuse ranges from 4-16 percent of the number of deaths from the underlying cause. Age, sex, and metropolitan status of residence are associated with a listing of chronic alcohol abuse among decedents of liver cancer, varicose veins, symptomatic heart disease, septicemia, and respiratory system disease. Planners concerned with secondary prevention can use these clues provided by logistic regression modelling as an aid in case-finding.

Adult↗

Meeting the challenges of social work research in long term care.

As the number of long-term care (LTC) residents increases, issues related to quality of care and quality of life will continue to be of concern. Research in this area is clearly needed, yet it presents a variety of challenges related to the nature of the institutional setting and the compromised functional status of residents. The social work calling to give voice to those who are least heard and most needy demands that we rise to these challenges. Based on the authors' experiences in conducting research in LTC, three types of challenges are identified and discussed: institutional, participant, and research design. Recommendations for addressing these challenges are offered.

Aged↗

[Study on the life expectancy of residents in Xinjiang Production and Construction Group, from 1997 to 1999].

OBJECTIVE: To understand the life expectancy of residents in Xinjiang production and Construction Group, from 1997 to 1999. METHODS: Stratified cluster sampling method was used to obtain mortality rate, sequence of death causes, life expectancy, life eliminated major cause of deaths, years of potential life lost (YPLL) and level of long life. These indeices were used to compare and analyze health status on residents in the area. RESULTS: The life expectancy on residents in the area was 75.61 years old for all residents, 72.73 years old for males, 80.02 years old for females from 1997 to 1999. The life expectancy for people living in agricultural and livestock farms was lower (73.97 years old). It was found that life expectancy was parallel to the level of economy. Life expectancy of northern residents was higher than those living in the southern and eastern parts of the area. The annual average mortality rate of the residents was 5.17 per thousand (standard mortality rate 4.02 per thousand ). The sequence of major causes of death was shown as below: malignant tumors, cerebrovascular diseases, respiratory system diseases, cardiac diseases, accidental deaths, infectious diseases, certain conditions originated in the perinatal period. In the life eliminated major cause of deaths, respiratory system diseases and certain conditions originated in the perinatal period were higher than others. In both sequences of YPLL and SYPLL for major causes of death, accidental death was always in the leading place. There was a higher longevity on residents from the better economic area. CONCLUSIONS: Higher life expectancy in the area was noticed, but the differences among the different area were bigger. In order to improve the level of health on all residents in the area, it is necessary to strengthen the administration on social and natural environment of the area. Furthermore, decreasing accidental deaths, controlling respiratory system diseases (especially for infant) and improving health care of infants in perinatal period are very important tasks in the area.

Adolescent↗

Summary health statistics for U.S. adults: National Health Interview Survey, 1998.

OBJECTIVES: This report presents health statistics from the 1998 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 attitudes toward acquired immunodeficiency syndrome (AIDS). Health statistics by education, income, health insurance coverage, marital status, and place of residence are also 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. Also, the self-reported health information for adults in this report was obtained from one randomly selected adult per family. HIGHLIGHTS: In 1998, 65% of adults 18 years of age and over reported excellent or very good health. However, 17% of adults less than 65 years of age had no health insurance coverage, and 14% of adults did not have a usual place of medical care. Twelve 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, and 23% 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 20% were obese.

Absenteeism↗

A comparison of the nutritional status of elderly Chinese living in different types of non-acute care institutions in Hong Kong.

The nutritional status of 191 elderly subjects living in three types of non-acute care institutions was studied by estimating nutrient intake and biochemical status. The dietary intake of women in the long-stay institution was similar to that of free-living elderly subjects. Dietary consumption of subjects living in a private nursing home and a convalescent unit were poorer than for elderly free-living subjects. Elderly women in all institutions had a poorer protein nutritional status, a poorer biochemical status of vitamin B12, folate, ascorbic acid, and vitamin D, and lower plasma potassium levels when compared with free-living elderly women. Those in the private nursing home and the convalescent unit had the poorest protein nutritional status. Among men, institutionalized subjects were observed to have poorer thiamine and riboflavine status, in addition to the above findings. The greater prevalence of chronic diseases and disability in the convalescent unit and the private nursing home may partly account for the poorer nutritional status of residents in these two institutions.

Aged↗

The investigation of a 'cluster' of hepatitis B in teenagers from an indigenous community in North Queensland.

BACKGROUND: In early 1999, five teenagers from the same Indigenous community were notified as having hepatitis B. Hepatitis B vaccine should have been offered to this cohort of teenagers in a 'catch-up' program during the late 1980s when they were of pre-school age. OBJECTIVES: To determine the vaccination status of residents of the community born between 1981 and 1985 (inclusive) and to ascertain the prevalence of markers of hepatitis B infection and carriage in the incompletely vaccinated teenagers in this cohort. METHODS: Community health records were examined to identify all residents in the study cohort. Immunisation records were obtained from local hospital records and from a statewide computerised vaccination database. Serological tests for markers of hepatitis B infection and carriage were performed on blood samples from the incompletely vaccinated teenagers. RESULTS: Only 44% of 235 teenagers who had their vaccination status assessed were fully vaccinated. One hundred and eleven (47%) of the cohort had not received any hepatitis B vaccine. Over 90% of the incompletely vaccinated had been infected with the hepatitis B virus and 26% of these were hepatitis B carriers. CONCLUSIONS: Despite the availability of an effective hepatitis B vaccine and the recommendation for a catch-up program, the pre-school aged cohort of children at the community were not effectively targeted for vaccination. Hepatitis B remains a consequential infection in Indigenous communities in North Queensland. IMPLICATIONS: Initiatives to control hepatitis B need to be enhanced within existing maternal and child health, sexual health, alcohol and drug and chronic disease management programs.

Adolescent↗

Black-white and urban-rural differences in stability of household composition among elderly persons.

The dynamic nature of household composition in a population of elderly persons, with particular focus on Black-White and urban-rural differences, is described in this study. The Duke EPESE is a stratified, random household sample (N = 4,162) of elderly persons in a five-county mixed urban-rural area of North Carolina with respondents contacted annually to report on health and social factors. Between 1986 and 1990, 35 percent of the households underwent some change in composition, with 14 percent contracting and/or expanding more than once. Where elders lived alone and where married elders lived with the spouse and/or others, Black elders were significantly more likely to experience a net expansion of their household than were White elders of the same age, gender, socioeconomic, and functional status. Elderly residents of rural areas who lived alone were slightly more likely to add one or more persons to their households than were comparable elderly urban residents. No additional risk of household instability was noted in sociodemographic or health-related subgroups by race or residence. Future analyses should examine the outcomes of instability.

Black or African American↗

[The assessment of the nutritional status and risk profile of elderly residents].

UNLABELLED: An observational study in a long term geriatric care institution and medical wards, to systematically introduce the assessment of nutritional status, cognitive function and risk profile of residents, allowed the identification of "at risk" patients. METHODS: Data were collected on 198 residents, over a period of 6 months. RESULTS: The mean age was 86.6 years (range 80-99). Some data were not available for 54 patients (i.e. story of weight loss 3 months before admission: all of them had >90 years); 49% of patients were higly dependent and 30% of patients were severely malnourished (malnutrition was prevalent in cancer patients). Of the 19 patients dead during the study 6 were malnuorished, 6 at risk and for 6 a thorough assessment was not possible. DISCUSSION: The prognostic importance weight loss over the last 6 months is widely aknowledged, however this information is not easily retrievable in geriatric populations; demented patients are more at risk of malnutrition. The collection of data on nutritional status allows the identification of patients who need a close surveillance and the implementation of preventive measures.

Aged↗

Characteristics associated with HIV-1 infection in pregnant women in Brazzaville, Congo.

Maternal human immunodeficiency virus type 1 (HIV-1) infection in sub-Saharan Africa is a major public health concern because of the high prevalence among women of childbearing age and the poor prognosis for perinatally infected children. Characteristics associated with HIV seroprevalence were studied in a population of 1,833 pregnant women seen in two large mother-child clinics in Brazzaville, Congo. The prevalence of HIV infection was 3.9% (95% confidence interval, 3.0-4.9%) and differed significantly according to the district of residence, marital status, duration of the relationship with the current partner, number of sexual partners in the year prior to pregnancy, number of living and dead children, and history of blood transfusion and/or hospitalization. Logistic regression analysis identified six significant factors independently associated with seropositivity; age, history of blood transfusion and/or hospitalization, district of residence, duration of the relationship, number of living children, and number of decreased children. However, the predictive value of the model was poor: while 80% of the truly positive women were correctly predicted positive by the model, 50% of the truly negative women were misclassified. Among pregnant women attending these clinics it is therefore difficult to identify a subgroup at risk toward which specific actions could be targeted.

Acquired Immunodeficiency Syndrome↗

Iron status markers in 224 indigenous Greenlanders: influence of age, residence and traditional foods.

OBJECTIVE: To evaluate iron status in indigenous Greenlanders and its relationship to gender, age and intake of traditional Greenlandic foods. METHODS: Serum ferritin, serum transferrin saturation and haemoglobin were evaluated in a population survey in 1993-1994 comprising 224 Greenlandic individuals (109 men) aged 19-82 yr. The participants were residents in the capital Nuuk (n=73) with a predominantly Western style of living, the town Ilulissat (n=60) with a mixture of Western and Greenlandic style of living, and the small town Uummannaq (n=91) with a predominantly Greenlandic style of living. Consumption of traditional foods was assessed by questionnaire. RESULTS: Intake of traditional foods was more prevalent among elderly than among young individuals and more frequent in Uummannaq than in Ilulissat and Nuuk. Ferritin levels were higher in men than in women (p<0.0001). Median ferritin levels were lowest in Nuuk (men, 92 microg/L; women, 40 microg/L), higher in Ilulissat (men, 104 microg/L; women, 69 microg/L) and in Uummannaq (men, 118 microg/L; women, 46 microg/L) (p<0.001). The prevalence of iron load (ferritin >200 microg/L) was lowest in Nuuk (men: 13.8%, women: 2.3%) intermediate in Ilulissat (men, 11.1%; women, 9.1%) and highest in Uummannaq (men, 32.1%; women, 21.1%). The prevalence of iron depletion (ferritin <16 microg/L) was high in Nuuk (men, 0%; women, 20.5%), and lower in Ilulissat (men, 3.7%; women, 6.1%) and in Uummannaq (men, 0%; women, 10.5%). The prevalence of iron deficiency anaemia (ferritin <13 microg/L and Hb <5th percentile for iron-replete men and women) was 0.92% in men and 0.87% in women. Correlations between age and ferritin were lowest in Nuuk (men, r(s)=0.26, p=0.2; women, r(s)=0.50, p=0.001) intermediary in Ilulissat (men, r(s)=0.37, p=0.06; women, r(s)=0.73, p<0.0001) and highest in Uummannaq (men, r(s)=0.59, p<0.0001; women, rs=0.74, p<0.0001). Intake of traditional foods was correlated with ferritin in men (r(s)=0.29, p=0.01) and women (r(s)=0.40, p<0.0001). CONCLUSION: The observed differences in estimated body iron stores in Greenlanders from the three residential areas can be explained by differences in the dietary intake of haem iron.

Adult↗

Consecutive autopsies on an internal medicine service.

OBJECTIVES: Autopsy rates continue to decline in the United States despite the demonstrated value of this procedure in many different settings. We sought to review clinical pathologic discordance information generated by autopsies on an internal medicine service in the urban United States and to determine whether resident services appear to influence autopsy rates. METHODS: We reviewed consecutive deaths and autopsies on an inpatient internal medicine service during a 30-month period at a 400-bed community hospital in Baltimore, MD. RESULTS: There were 622 deaths and 65 autopsies (10.3%). Resident teaching status correlated with a higher rate of autopsies performed (P = 0.048). Clinical pathologic discordance was common, with a major discordance rate of 39%. Major discordance was indicated by only one of nine autopsies performed on patients with human immunodeficiency virus. CONCLUSIONS: The autopsy was a valuable educational and quality improvement tool on the urban internal medicine service. Residency influences may be a major factor in continuing this exercise. In our study, although the numbers were small, patients with human immunodeficiency virus had a very low discordance rate.

Adolescent↗

Cervical screening by socio-economic status in Australia.

OBJECTIVES: To examine differentials and time trends in self-reported Pap test rates by socio-economic status (SES) from the 1989/90 and 1995 Australian National Health Surveys (NHS). METHODS: The unit record data for females were extracted from the two NHSs and combined. The outcome variable of interest was 'having a Pap test in the past three years'. The principal study factor was SES measured as individual characteristics and SES of area of residence. Migrant status, rurality, year of survey and age were controlled for in logistic regression models. RESULTS: Self-reported rates of having a Pap test in the past three years were higher in women from higher compared with lower SES groups. Compared with women with a bachelor or higher degree, the odds of reporting having a Pap test in the past three years in women with no post-school qualification was 0.86 (p<0.0005). Women with a gross annual income of less than $20,000 had significantly lower odds (OR=0.79) compared with women earning $40,000 or more. Blue collar (OR=0.84) and not employed (OR=0.73) women also had significantly lower odds compared to the referent white collar group. CONCLUSION: This study reveals differentials in Pap screening behaviour by individual measures of SES in Australia. Area-based SES measures under-estimated the SES differentials in Pap test rates compared with individual measures. Derived population attributable fractions reveal that about a quarter of self-reported under-screening is accounted for by low SES when measured individually, compared to 8% when SES is measured ecologically.

Australia↗