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PubMed1998

Statistical aspects of measuring change in oral health status of older adults.

There are many statistical aspects involved in the measurement of change and some of these are discussed in this paper. First, a general overview of the three types of index, discriminative, predictive and evaluative, is presented. Each type of index should be developed in a different manner and this will depend on its use. For example, the reliability of an evaluative index is different from that of the other types of index and would depend on the observations on each individual remaining stable over time, and having a large change score when the dental status improves or deteriorates. Second, the issue of when we should be measuring change as opposed to just using the final measurement, or to using an analysis of covariance, is discussed. The final section of the paper looks at some of the fallacies which occur in the measurement of change and discusses whether or not we should try to correct for these.

Aged↗
PubMed2005

The road to reform.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed2000

Depression: dispirited or spiritually deprived?

The 20th century has seen a widespread decline in mental health in Western society. One important factor may be the lack of meaning and spiritual fulfilment that is part of our increasingly secular and materialistic society. In medical education and practice, religious issues are often marginalised or 'pathologised", despite consistent evidence from the literature of the protective effect of "religiosity" or "spirituality" on mental and physical health.

Depression↗
PubMed1997

Integrating clinical and support process design for effective health services.

With increased capitation and managed care competition, health care systems must demonstrate effective health services with predictable costs, timing, transitions, and health outcomes. By involving patients, payers, and multiple providers, a health care system can design integrated clinical and support processes across the continuum for defined populations. The goals are lower costs, increased payer and patient satisfaction, and improved health status. This article shares examples and experiences from four health care systems that teamed with Premier, Inc., to design an integrated services sequence for defined populations.

Adult↗
PubMed2004

The evolving impact of aging America on dental practice.

American dentistry has recognized for a quarter century that the growth in the proportion of elderly in the population is impacting on the profession. Multiple articles in the professional literature have speculated on the ways in which this change will be manifested. Data and projections from earlier articles are revisited and five trends are offered to guide professionals as they position their practices for the coming years. The increase in number and proportion of elderly in dental practices stems from successes in preventing and controlling infectious diseases during the last century. The trend has not peaked but will continue for at least two more decades. Retention of teeth into advanced age has resulted from emerging and improved preventive and restorative dental advances directed at children and adults beginning mid-century, and dental utilization studies confirm the elderly are seeking dental care at an unprecedented and growing rate. Chronic disease and infirmity that accompany advanced age make dental care more challenging for this group. Dentists and their staff will need to continuously undertake educational opportunities that will foster and maintain their facility in providing care to the elderly. They will need to do this because Americans of advanced age are becoming the dominant age group seeking, and able to pay for, sophisticated dental services. The blend of those services is shifting away from removable prostheses to a rising demand for restorative, periodontic, and endodontic care. Root caries, in particular, will be a growing challenge to both providers and patients. There is mounting evidence oral disease impacts endocrine, cardiovascular, and pulmonary health, particularly in frail elders, and will likely provide many elderly additional stimuli to seek dental care. Providers who seek an alternative approach for delivering their services will find growing demand for and satisfaction with traveling to patients, rather than the other way around.

Aged↗
PubMed1999

The complex realities of primary prevention for HIV infection in a "just do it" world.

Primary prevention of HIV requires behavior changes to decrease the risk of sexual, drug using, and occupational exposure to infection. The difficulties associated with behavior change are related to social, cultural, and political constraints that reinforce heterosexism, sexism, and racism. These problems are compounded by concurrent epidemics of violence, poverty, and drug use, and are made more difficult by the absolutist mentality. Use of theory-based interventions, awareness of community attributes, and a change to pragmatic political agendas can help in the development of effective prevention programs.

HIV Infections↗
PubMed2000

Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 1993-1994.

In the beginning of 1992, in order to do away with the ruins of the old communist system once and for all, radical economic reforms--'shock therapy'--were introduced in Russia. However, there are winners and losers in the Russian transition from communism to market economy and democracy. The aim of the study is to investigate whether there are educational differences in self-rated health among the citizens of Taganrog in 1993-94. If there are indeed differences, the second aim is to investigate whether they can be explained by variations in specific social, economic and psychological circumstances, which are known to be affected by the present social and economic transformation in Russia. The analysed survey was carried out in a middle-sized Russian city, Taganrog, in late 1993 and early 1994. It was conducted by means of face-to-face interviews, with a sampling frame consisting of dwellings selected from an official register and stratified by type and size. The analysed sample consists of 2372 respondents, aged 25-54 years, in 1414 households. Data were analysed in logistic regressions with self-rated health as a dichotomised outcome variable. The results show that those with less than compulsory education reported poor health twice as often as the highest-educated group. Material prosperity and relations within the family were important for self-rated health and explained to a certain degree the educational health differences. Lower educational groups now live under conditions often characterised by economic hardship, family conflicts, etc., and consequently also poor health.

Adaptation, Psychological↗
PubMed2005

Changing social variations in self-assessed health in times of transition? The Baltic States 1994-1999.

BACKGROUND: Dramatic social changes took place in the Baltic States (Estonia, Latvia and Lithuania) in the 1990s. This study investigates the extent to which social variations in self-assessed health changed during that period. METHODS: Norbalt Living Conditions Survey I (1994) and II (1999) random population-based samples in Estonia, Latvia and Lithuania were analysed. Associations of self-assessed health with six social dimensions (education, economic activity, car ownership, number of rooms, ethnicity and residence) were studied for males and females aged 25-74 years (n = 16 970). RESULTS: Substantial and significant associations with poor health were found for education, economic activity, car ownership and, to a lesser extent, number of rooms. Ethnic differences were found only among women in Estonia. By and large, social variations in health were comparable for most indicators between the three countries. Differences in self-assessed health were stable between 1994 and 1999, except for the relatively worse position of the economically non-active in 1999. CONCLUSIONS: Substantial social inequalities in self-assessed poor health exist in the Baltic States. Despite dramatic social changes taking place, social variations in self-assessed health have been rather stable in the second half of the 1990s. The economically non-active seem to have become more disadvantaged.

Adult↗