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PubMed2002

[Changes in nutritional status and nutritional intake among elderly residents of a community over a 10-year period: the Hisayama Study].

The purpose of this study was to investigate the changes in nutritional status and nutrient intake among 387 elderly residents (> or = 60 y.o.) of Hisayama Town. A dietary survey was carried out at baseline in 1988 and repeated at the end of the follow-up period in 1998. During the 10-year follow-up period, mean values of body height and weight, and body mass index significantly decreased in both sexes. Likewise, blood hemoglobin and serum total cholesterol levels significantly decreased, while serum albumin and HDL-cholesterol levels significantly increased. Among dietary factors, mean energy intake significantly decreased due mainly to a decrease in the amount of carbohydrate intake, but no significant changes in the amount of protein and fat intakes were observed. The percentages of the Recommended Dietary Allowance for all nutrients eaten except for iron changed at the levels above 100%. The percentage of energy derived from carbohydrate significantly decreased, while those from protein and fat significantly increased. In conclusion, among community-dwelling healthy elderly people, mean energy intake significantly decreased due to a decrease in the amount of carbohydrate intake, and the fat intake relatively increased, with advancing age, but the blood lipid profile remained unchanged.

Aged↗
PubMed2002

The six-month incidence of clinically significant low back pain in the Saskatchewan adult population.

STUDY DESIGN: A population-based, longitudinal, mailed survey was conducted. OBJECTIVE: To investigate the 6-month incidence and determinants of clinically significant low back pain in the Saskatchewan adult population. SUMMARY OF BACKGROUND DATA: Few studies have investigated the incidence of significant low back pain in general populations. When available, such studies often differ in the assessment of pain severity. This lack of consensus in measuring pain severity results in large differences in incidence rates. METHODS: A questionnaire requesting information on low back pain and other health conditions was mailed to randomly chosen individuals, ages 20 to 69, residing in the province of Saskatchewan, Canada. Of the 1131 (55%) who responded at baseline, 848 had not experienced clinically significant low back pain during the past 6 months. Clinically significant low back pain was assessed using the Chronic Pain Questionnaire, a 7-item scale that measures the intensity of chronic pain and associated disability. Individuals with no clinically significant low back pain were followed up at 6 months. RESULTS: At the follow-up assessment, 50 individuals reported clinically significant low back pain, representing a cumulative incidence of 8% (95% confidence interval, 6-10.4). In logistic regression models, marital status, rural residency, and history of back and neck pain were associated with the onset of clinically significant low back pain. CONCLUSIONS: The 6-month incidence of clinically significant low back pain is high in Saskatchewan. It is important to prevent this condition because of the high economic and social costs associated with it.

Adult↗
PubMed1998

Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes.

OBJECTIVE: To describe the type and frequency of drug-related problems discussed in regular team meetings conducted in 15 Swedish nursing homes and report physician and staff assessments of these interventions and residents' outcomes. DATA SOURCES AND METHODS: The data were collected within the context of a controlled trial with the primary aim of exploring the effects of regular team interventions on drug prescribing practices in Swedish nursing homes. In 15 experimental nursing homes, the residents' drug therapy was discussed regularly by a team consisting of a pharmacist, a physician, nurses, undernurses (similar to licensed practical nurses), and nurse's aides. The pharmacist documented problems, made changes, and observed outcomes. Following the intervention period, a questionnaire was sent to the medical staff that contained items regarding perceived outcomes, the intervention's impact on knowledge of drug therapy in the elderly, and attitudes toward the pharmacist's role. RESULTS: Unclear indication and problematic choice of drugs were the most common drug-related problems discussed. In 19% of the situations, therapy changes were reported to have had a beneficial effect on the residents' clinical status; in 47% of the situations, staff reported no observable outcome from changes, suggesting that the changes had been appropriate. Finally, medical staff claimed in the follow-up survey that their knowledge about drug therapy had increased; they expressed an overall positive attitude toward this interactive collaboration. CONCLUSIONS: Regular intervention conducted by a multidisciplinary team incorporating a pharmacist can effectively improve prescribing practices, increase staff knowledge about appropriate drug therapy in the elderly, and result in improved quality of care for nursing home residents.

Aged↗
PubMed1996

Family practice residency training capacity in Wisconsin: current status and future projections.

BACKGROUND: High quality health care depends on superior training and outstanding residency opportunities for new physicians of all types, especially those entering family practice. But concern over the availability of adequate opportunity has caused the medical community concern across the country. Wisconsin is no different. To estimate future residency needs in the Badger State, we examined recent trends in specialty selection and information gathered from 1995 medical school graduates entering family practice residency training here and in other states. We surveyed all Wisconsin medical school graduates entering family practice training positions in July 1995, asking them to rank in-state and out-of-state programs, as well as graduates' motivations for selecting those programs. RESULTS: Response rates to our surveys were exceptional. A full 86% (n = 30) those entering residency in Wisconsin and 95% (n = 18) for those in out-of-state programs responded. One graduate who entered a Wisconsin program ranked an out-of-state program higher and one graduate who entered an out-of-state program ranked a Wisconsin program higher than their ultimate residency sites. Not surprisingly, the variable most predictive of whether students pursued training in Wisconsin rather than out-of-state was the student's state of residency before entering medical school. CONCLUSIONS: The resulting trends show positive trends toward state-based family practice training, but may not be as optimistic as experts first predicted. If interest in family practice rises to goals set by the state's medical schools, more training positions will be needed, but not as many as proposed in medical school plans to the state Legislature.

Career Choice↗
PubMed1996

[Nutrition and health status of schoolchildren in Brianskaia region, residing in territories polluted by radionuclides].

Dietary intake, physical development and some indicator of health status of schoolchildren of Novosybkov (2th zone of strict control) and Vyshkov (3th zone) were studied. Energy and macronutrient intakes for schoolchildren can be considered adequate. Dietary intake intake of vitamins A, E, beta-carotene and especially C, and calcium were rather low. Low intakes of vitamin and calcium are results from low dietary consumption of milk and diary products, fruits and vegetables Physical development of Novosybkov's children is considered adequate and do not differ from that of Moscow's schoolchildren. The frequency of obese schoolchildren was seen in Novosybkov's children in comparison with Moscow's ones. On the contrary, among rural Vyshkov's children the high frequency of children with deficit of body mass was examined. The number of children relating to 2 or 3 groups of health was higher in Novosybkov than in Moscow. The data about higher prevalence of child morbidity were supported. One of risk factors of decreasing of children body toleration to low level of radiation are low level of vitamin intake and other defects of health nutrition.

Adolescent↗
PubMed2005

A study of Pap test history and histologically determined cervical cancer in NSW women, 1997-2003.

OBJECTIVES: To determine the risk of a histological diagnosis of cervical cancer following a given Pap test result and for a given history of Pap test results in a screened population across the full spectrum of possible cytological results. METHODS: All the Pap screening results held on the New South Wales Pap Test Register for 1997-2003 (five million tests for 1.87 million women) were analysed using Cox proportional hazards regression to estimate the odds of having a histologically determined cervical cancer for a given Pap test result and test result history. The hazard ratios of having cervical cancer in relation to Pap test result histories were estimated: (i) in regard only to the last Pap test result adjusting for age, frequency of Pap testing and proportion of high grade (>or=cervical intraepithelial neoplasia 2 [CIN2]) abnormalities found in a woman's total recorded test result history; and (ii) with regard to the last Pap test result against the highest grade of cytological abnormality found prior to the last Pap test result. The hazard ratios are for a cancer diagnosis occurring before the next Pap test and were adjusted for age, quintile of socioeconomic status of residence, frequency of past Pap testing and proportion of high-grade abnormalities detected in each woman's prior Pap test history. The adjusted hazard ratios were then applied to the tabulated proportions of referent women with negative cytology in each broad age group, and for all women, to estimate the '1 in n' odds of being diagnosed histologically with cervical cancer for a given last Pap test result, and by a given last Pap test result for various prior Pap test result histories. RESULTS: After adjusting for age, socioeconomic status, frequency of previous Pap testing and proportion of past high-grade screen-detected abnormalities, the adjusted hazard ratio of having a subsequent cervical cancer diagnosis for women with a negative Pap test result was 1 in 5,546, compared with 1 in 833 for a low-grade epithelial abnormality (atypia, CIN1), 1 in 56 for a high-grade epithelial abnormality and 1 in seven for a cytological prediction of cervical cancer. These odds estimates were significantly modified by age and by the highest Pap test result prior to the most recent Pap test result: the higher the age and, less consistently, the higher the previous highest Pap test result for a given last Pap test result, the shorter the odds of having a subsequent histological diagnosis of cervical cancer. CONCLUSIONS: The results presented here will enable clinicians to inform their patients of their chances of being diagnosed with cervical cancer for a given Pap test result, and for some combinations of the last Pap test result and highest recorded prior Pap test result.

Adolescent↗
PubMed1995

Epidemiology of do-not-resuscitate orders. Disparity by age, diagnosis, gender, race, and functional impairment.

BACKGROUND: The relationship of do-not-resuscitate (DNR) orders to patient and hospital characteristics has not been well characterized. METHODS: This observational study of a nationally representative sample of 14,008 Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, or hip fracture evaluated the relationship of DNR orders to patient sickness at admission, functional impairment, age, disease, race, gender, preadmission residence, insurance status, and hospital characteristics. RESULTS: Of the 14,008 patients, DNR orders were assigned to 11.6%. Patients with greater sickness at admission and functional impairment received more DNR orders (P < .001) but even among patients in the sickest quartile (with a 65% chance of death within 180 days), only 31% received DNR orders. The DNR orders were assigned more often to older patients after adjustment for sickness at admission and functional impairment (P < .001), and DNR order rates differed by diagnosis (P < .001). After adjustment for patient and hospital characteristics, DNR orders were assigned more often to women and patients with dementia or incontinence and were assigned less often to black patients, patients with Medicaid insurance, and patients in rural hospitals. CONCLUSIONS: Do-not-resuscitate orders are assigned more often to sicker patients but may be underused even among the most sick. Sickness at admission and functional impairment do not explain the increase in DNR orders with age or the disparity across diagnosis. Further evaluation is needed into whether variation in DNR order rates with age, diagnosis, race, gender, insurance status, and rural location represents differences in patient preferences or care compromising patient autonomy.

Age Distribution↗
PubMed2002

[Structured patient education in oncology. A prospective study for implementing and effectiveness of interdisciplinary psycho-educational group intervention at a German university clinic].

AIM: To identify the target group for a structured educational group intervention in an acute cancer care setting, and to prove its effectiveness. PATIENTS AND METHODS: Cancer patients were given an opportunity to join an educational group intervention lasting 3 weeks (consisting of six times 1 hour). The intervention consisted of two major components: health education and coping skills. Participating patients (intervention group; n = 51) and nonparticipants (control group; n = 57) were evaluated at the beginning, then 2 months and 4 months later by means of standardized questionnaires (EORTC QLQ-C30, TSK, HADS, Henrich's FTP). RESULTS: Lower social and educational status, nonurban residency, males, and unfavorable prognoses together with palliative treatment intention were found less frequently (p < 0.05) in the intervention group. In comparison to the control group, the intervention group patients were characterized by a significantly greater desire for information and by more treatment-related fear. Improvements in disease-specific knowledge, certain quality of life elements, and in coping occurred only in the intervention group. Increases in the incidence of depression were found only in the control group. CONCLUSION: Patients with a more favorable prognosis, and a higher social and educational status, are more likely to get structured educational group intervention in an acute cancer care setting. For this subset of patients this intervention proves effective. Its importance for the standard care of cancer should be further investigated.

Adaptation, Psychological↗
PubMed1986

Employment rates among the disabled in Israel.

Seven hundred sixty two disabled individuals were interviewed. Of these, 220 were found to be working or to have done so in the past three years. The remaining 542 were unemployed and had been so for at least that long. Employment status was found to be related to a number of demographic and disability related variables: sex, with whom the subject lived, country of origin, father's country of origin, and SES. The employed were more likely to be male, to live in an upper middle or upper class neighborhood, to be Israeli born, have European or American born fathers, and to be living with someone else. They were also likely to be more educated, younger, have a lower disability degree, a less serious medical disability, and have more recent disabilities. The other variables studies, including place of residence, family status, year of immigration, number of children, and several specific disability related measures, were not related to employment status. The findings are in keeping with those of previous studies. Their implications for improving employment rates among the disabled are discussed.

Adolescent↗
PubMed2002

Weekly chloroquine prophylaxis and the effect on maternal haemoglobin status at delivery.

Our aim was to determine the effectiveness of chloroquine prophylaxis in reducing the frequency of malaria-induced anaemia at delivery. We estimated the haemoglobin levels of 207 parturients; 82 (39.6%) had been on chloroquine prophylaxis [treatment group (TG)] while 125 (60.4%) did not take any malaria preventive medication antenatally [control group (CG)]. The proportion of women with malaria parasitaemia was significantly higher in CG than TG [risk ratio (RR=1.57, CI=1.05-2.34)]. The dose-response relationship between the severity of parasitaemia and the risk of being anaemic (P < 0.001) confirms a strong correlation between gestational malaria and maternal anaemia. There was a 35% reduction in risk for anaemia in the TG compared with the CG (RR=0.65, 0.40-1.06). The difference in risk was more pronounced after adjusting for disparity in place of residence, educational status and obstetric history (adjusted RR=0.54, CI=0.21-0.98). Primiparous mothers appeared to have benefited more from the antianaemic effects of malaria chemoprevention than mothers of higher parity (protective effectiveness 43% compared with 33%, respectively). In conclusion, despite reports of widespread Plasmodium falciparum resistance to chloroquine on the African continent, malaria chemosuppression with the drug was found beneficial in reducing the risk of anaemia at delivery among Cameroonian women.

Adult↗
PubMedDate not supplied

A comparison of Portuguese and American patients with hematological malignancies: a cross-cultural survey of health-related quality of life.

This study investigates health-related quality of life (QoL) differences between 98 Portuguese and 109 US American outpatients with hematological malignancies. These two national groups of patients were characterized in terms of patients' QoL, and socio-demographic and clinical variables. Differences were found for several socio-demographic variables (race, marital and job status, urban residence, diagnosis, age, education, and household size). Portuguese patients reported better physical functioning, less bodily pain, more vitality, better social functioning, and better general QoL [as measured by Functional Living Index-Cancer (FLIC) total score] than American patients. Results were independent of demographic differences or mode of questionnaire administration.

Adaptation, Psychological↗
PubMed2004

Nutritional status of Saudi males living in the Riyadh nursing home.

This study evaluated the nutritional status of residents in the Riyadh nursing home, using anthropometric and haematological measurements. All male residents (N=84; age range 24-80 years) in the Riyadh nursing home were included in the study. Weight, height, body mass index, triceps skin fold thickness, and mid-arm muscle circumference were measured. Furthermore, serum concentrations of albumin, haemoglobin and haematocrit were measured. About 13% of adult residents and 11% of elderly residents were considered to be underweight (body mass index <18.5 kg/m(2)). From estimations of fat mass in the periphery, using triceps skin fold thickness, it appears that the elderly residents had significantly lower fat mass compared to the adult residents (P <0.05). The results showed that more than 40% of residents had low mid-arm muscle circumference (<22.3 cm). Serum albumin concentration was significantly lower in the elderly group than in the adult group (P<0.01). No significant difference was found in haematocrit level between the adult and elderly residents. Within the adult group, about 38% of residents had low haemoglobin level (<12 mg/dl), and this proportion was even higher, about 55%, in elderly residents. Based on body mass index or albumin to determine the prevalence of malnutrition among residents, the results have shown that the prevalence of undernourished residents was not higher than the prevalence of undernourished nursing-home residents reported in other studies. The percentage of elderly residents with anaemia was appreciable. Thus, undernourished and anemic residents should have special dietary and medical attention. Early detection of malnutrition upon admission would lead to early intervention and thus to reduced complications and medical-treatment costs. Staff working in nursing homes should be aware of the nutritional guidelines for health and disease.

Adult↗
PubMed1994

Patterns and predictors of institutionalization in community-based dementia patients.

OBJECTIVE: To investigate patterns and predictors of institutionalization in a community-based sample of dementia patients. SETTING: The Mayo Clinic Alzheimer's Disease Patient Registry (ADPR), a community-based prospective registry. PATIENTS: Two hundred seventy-five participants, including 145 dementia patients and 130 controls on whom longitudinal follow-up data was available. The mean ages were 79.9 and 78.8 years, and the mean Mini-Mental State Examination (MMSE) scores at enrollment were 22.1 and 28.1 points for the demented cases and controls, respectively. MEASURES: Place of residence, marital status, number of direct support providers, global cognitive status, activities of daily living and instrumental activities of daily living were used in hazards modeling of institutionalization. RESULTS: The results from our community-based sample suggest a high rate of institutionalization for dementia patients. One-half of the sample of dementia patients were institutionalized within 2.5 years of enrollment in our patient registry. Identified assistance providers were absent in a significant proportion (36%) of our dementia sample. Marital status, global cognitive function, and functional status were significant terms in hazards models of institutionalization. Age, gender, number of direct caregivers, and dementia etiology were not associated with significant risk. Seventy-two percent of the dementia patients who died over the course of this study had been placed in nursing home care prior to death (with a mean length of stay of 2.8 years). CONCLUSIONS: Social (marital status) and disease-related variables (cognitive and functional status) are related to risk for institutionalization. These variables may be useful in estimating time to institutionalization in various clinical and research populations.

Aged↗
PubMed1986

Behavioural, physiological and immunological consequences of social status and aggression in chronically coexisting resident-intruder dyads of male rats.

The behavioural and physiological consequences of social status and reciprocal fighting in resident-intruder dyads of Long Evans male rats were evaluated. Before a chronic cohabitation of 10 days, residents and intruders were individually housed for one month to increase their aggressiveness. Control animals included isolates, i.e., animals kept individually housed throughout the experiment and pair-housed rats, i.e., pairs of rats housed together from their rats in the laboratory. In 19 out of 20 dyads, a clear dominance relationship developed with an advantage to the resident in 68% of the cases. Dominants showed more exploratory activity than subordinates in a open-field test at the end of the cohabitation period; subordinates groomed longer than animals from other experimental groups. Dominants had lower pain thresholds than individually and pair-housed animals. Both dominants and subordinates had higher tyrosine hydroxylase enzymatic activities in the left adrenal than isolated and pair-housed rats. Subordinates lost body weight and had higher plasma corticosteroid concentrations than animals from the other experimental groups. In addition, they had smaller thymus glands and reduced spleen lymphocyte responses to mitogenic stimulation in vitro, in comparison to dominant animals. These results show that subordination in the dyadic resident-intruder paradigm leads to a complex syndrome of behavioural and physiological changes, some of which may be modulated by the intensity of aggressive interactions.

Adrenal Glands↗
PubMed2001

Outcome of older patients requiring ventilatory support in intensive care: impact of nutritional status.

OBJECTIVES: To determine predictors of mortality in the intensive care unit (ICU) and at 6 months after discharge; to assess the lifestyles of survivors 6 months after discharge. DESIGN: Prospective cohort study of patients screened upon admission and 6 months after discharge from the ICU. SETTING: The ICU of a university hospital. PARTICIPANTS: One hundred sixteen consecutive patients age 70 and older admitted to the ICU and treated by mechanical ventilation for at least 24 hours. MEASUREMENTS: A comprehensive medical, functional, nutritional, and social assessment was undertaken for each patient upon admission to the ICU. Functional status and residence were recorded for patients still living 6 months after discharge from the ICU. RESULTS: Mortality in the ICU and 6 months after discharge was 31% and 52%, respectively. The predictors of in-ICU mortality on multivariate analysis were a high omega score per day in the ICU and a high simplified acute physiologic score corrected for points related to age (SAPS IIc). The predictors of mortality at 6 months were a high omega score per day in the ICU, a high SAPS IIc, and a mid-arm circumference (MAC) under the 10th percentile for the older French population in good health. Six months after discharge from the ICU, 91% of the surviving patients had the same residential status and 89% had a similar or improved functional status compared with pre-admission status. CONCLUSIONS: Although severity of illness remains an important predictor of in-ICU mortality and mortality at 6 months after release from ICU, we found that impaired nutritional status upon admission was related to 6-month mortality. These results emphasize the need for a systematic nutritional assessment in older patients admitted to the ICU and treated by mechanical ventilation.

APACHE↗
PubMed1987

Incidence of protein calorie malnutrition in the nursing home population.

That nutritional parameters change with age is a well-known phenomenon. Physical activity, lean body mass, and metabolic rate all decline with increasing age. There has been little work regarding the nutritional assessment of geriatric nursing home patients to determine their nutritional status and to focus attention on their nutritional needs. The purpose of this study was to assess the nutritional status of the residents of two urban nursing homes. The nutritional status of 227 nursing home residents (mean age 72.2 years) was evaluated using biochemical and anthropometric measurements. Midarm muscle circumference, triceps skinfold thickness, weight, height, serum albumin, serum pre-albumin, serum retinol binding protein, and a complete blood count with differential were obtained. The evaluation of this data indicated that there was a 52% incidence of malnutrition. This can be broken down to: 24% hypoalbuminemic malnutrition, 19% Kwashiokor-Marasmus mix, and 9% Marasmus. Twenty-eight percent of all patients were anergic, and 76% of the patients were anemic. In conclusion, there appears to be far more documentable malnutrition than anticipated or previously reported in this population.

Aged↗
PubMed1999

A research registry: uses, development, and accuracy.

Many studies of population health, clinical epidemiology, and health services can be supported by a population-based research registry. Such a registry accurately defines the health insurance status for each individual over many years, magnifying the effectiveness of a cross-sectional registry (typically relevant for only a short duration) used in the administration of a health insurance plan. A research registry can distinguish between "well" individuals (no contact with the health care system), loss to follow-up (ineligibility associated with leaving the insurance plan), loss of continuity (two or more unlinked registrations over time for the same person), and mortality. The Manitoba research registry was developed to facilitate longitudinal studies; working within strict confidentiality controls, identifiers for each individual known to Manitoba Health since 1970 can be retrieved and a single unique identifier assigned. Careful reporting of changes in family registration numbers has enabled tracing area of residence, marital status, and family characteristics; results are equivalent to a daily census of the province. This article provides details on source materials, design, and quality of the registry, highlighting its value both for the development of integrated population health information systems and for research in general.

Adolescent↗