STATUS OF TRAINING OF RADIOLOGY RESIDENTS IN SPECIAL PROCEDURES IN THE UNITED STATES.
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Postprandial increases in serum antioxidant capacity in older women.
Eight women were recruited for studying the effects of a meal on overall antioxidant status. Subjects resided in a metabolic research unit for two 36-h periods. During period A, subjects fasted overnight (12 h) and were then given a breakfast, a lunch, a snack, and a dinner. During period B, subjects fasted for 23 h and were then given a dinner. These meals were designed to contain negligible antioxidants. Blood samples were collected for analyzing total antioxidant capacity (TAC) and individual antioxidants. The results showed that serum TAC significantly increased by up to 23% after the consumption of the lunch and dinner during period A. Serum TAC did not increase until after the consumption of the dinner during period B. Among the antioxidants (vitamin C, alpha-tocopherol, bilirubin, and uric acid) examined, serum uric acid was the only one that showed a significant postprandial increase, which was also parallel to the postprandial response in serum TAC. These results indicate that food intake, even if low in antioxidants, can increase the serum total antioxidant activity.
Aged↗
Low 25-hydroxyvitamin D and normal serum calcium concentrations in Saudi Arabia: Riyadh region.
Serum levels of the circulating form of vitamin D, 25-hydroxyvitamin D, and calcium were measured in 104 Saudis, 44 Jordanians , 17 Egyptians and 10 other subjects aged between 18 and 23 years. All subjects were male university students living in Riyadh for more than 2 years. 25-Hydroxyvitamin D levels were (mean +/- SD) 12.8 +/- 6.3, 11.0 +/- 5.8, 11.9 +/- 6.9 and 11.9 +/- 5.0 ng/ml, respectively. The percentages of subjects with serum 25-hydroxyvitamin D levels below 10 ng/ml were 35, 45, 53 and 50% for normal Saudis, Jordanians , Egyptians and others, respectively. All subjects had normal serum calcium concentrations. There was no correlation between 25-hydroxyvitamin D and serum calcium levels in the subjects investigated. This study indicates a tendency for a low vitamin D status among residents of Saudi Arabia, in spite of abundant sunlight all the year round.
25-Hydroxyvitamin D 2↗
Performance of a statistical model to predict stroke outcome in the context of a large, simple, randomized, controlled trial of feeding.
BACKGROUND AND PURPOSE: Statistical models to predict the outcome of stroke patients have several uses. Their utility depends on their predictive accuracy in patients other than those on whom they were developed (ie, external validity). We sought to test the external validity of some recently described models in patients enrolled in the FOOD (Feed Or Ordinary Diet) trial: a large randomized trial evaluating feeding policies in patients with stroke. METHODS: The predictive variables were collected during a telephone call to randomize the patient a median of 5 days after stroke onset. Patients were followed up 6 months later to establish their survival, functional status, and residence. Charts were plotted to demonstrate the discrimination and calibration of the models. RESULTS: The models performed well in the first 2955 patients enrolled and followed up in the FOOD trial. The area under the receiver operating characteristic curves varied between 0.78 and 0.81 (with 0.5 indicating no discrimination and 1.0 indicating perfect discrimination). The discrimination was marginally better for patients enrolled within the first day of stroke than later. The models tended to provide rather pessimistic predictions in all groups except those predicted to have a high likelihood of surviving free of dependency. CONCLUSIONS: As one might predict, the discriminatory power in the selected cohort of trial patients was marginally less good than in previously studied unselected cohorts used to test their external validity. These models provide a well-tested tool for stratification in trials, comparing outcomes in different cohorts and examining the additional predictive power of novel factors.
Aged↗
The effect of a stroke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost. A community-based study.
BACKGROUND AND PURPOSE: Treatment of stroke patients in specialized stroke units has become more frequent, yet the effect of this treatment has not been determined. METHODS: In a community-based, prospective, and consecutive study of 1241 unselected acute stroke patients, we compared outcome of stroke treatment between two neighboring communities within Greater Copenhagen: the Bispebjerg community, where all acute stroke patients are treated and rehabilitated on a stroke unit, and Frederiksberg community, where all acute stroke patients are treated and rehabilitated on general neurological and medical wards. Except for the different organization of stroke treatment, the two communities and the two patient groups were comparable. Specifically, age, sex, marital status, prestroke residence, and stroke severity were not statistically different between patients treated on the stroke unit and those treated on the general neurological and medical wards. Multivariate regression analyses were used to estimate the independent influence of stroke unit treatment on outcome. RESULTS: Stroke unit treatment significantly reduced in-hospital mortality (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.34 to 0.74; P < .001), case-fatality rate (OR, 0.45; CI, 0.28 to 0.71; P < .001), 6-month mortality (OR, 0.57; CI, 0.39 to 0.82; P = .002), 1-year mortality (OR, 0.59; CI, 0.42 to 0.84; P = .003), and discharge rate to a nursing home (OR, 0.61; CI, 0.38 to 0.98; P = .04). Discharge rate to the patient's own home was significantly increased (OR, 1.90; CI, 1.30 to 2.70; P < .001). The length of hospital stay (including rehabilitation) was reduced significantly by 30% in patients treated on the stroke unit despite their lower mortality (P < .001). The savings due to stroke unit treatment were estimated at 1313 bed-days and three places at a nursing home per 100 stroke patients. CONCLUSIONS: Treatment of unselected acute stroke patients on a stroke care unit saved lives, reduced the length of hospital stay, reduced the frequency of discharge to a nursing home, and potentially reduced cost.
Aged↗
Exposure-response relationships between occupational exposures and chronic respiratory illness: a community-based study.
Data from a random sample of 3,606 adults 40 to 69 yr of age residing in Beijing, China, were analyzed to investigate the association of reported occupational exposures to dusts and gases/fumes with the prevalence of chronic respiratory symptoms and level of pulmonary function. The prevalence of occupational dust exposure was 32%, and gas or fume exposure, 19%. After we adjusted for age, sex, area of residence, smoking status, coal stove heating, and education, an increased prevalence of chronic phlegm and breathlessness was significantly related to both types of exposures. Chronic cough was significantly related only to dust exposure, and persistent wheeze only to fume exposure. The global estimates of the relative odds of the four symptoms were 1.30 (95% CI [confidence interval] 1.09 to 1.48) and 1.27 (95% CI 1.09 to 1.48), respectively, for dusts and for gases/fumes. These two occupational exposures are associated with chronic respiratory symptoms independent of smoking, gender, and each other. There was an increasing prevalence of each symptom with increasing dust and fume exposure, represented by the index of cumulative exposure duration and exposure intensity. Linear trends for increased prevalence of chronic bronchitis and breathlessness were significant for both exposures, while the linear trend for wheeze was only significant for gases/fumes. Among subjects who did not report using coal stove heating, dust exposure was a significant predictor for FEV1, FEV1/FVC, FEF25-75, and peak expiratory flow rate (PEFR). There was also a significant decrease for FEV1 and FVC with increase of gas/fume exposure levels. Both current and former smokers appeared to be more susceptible to the effect of dusts than the never smokers.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Hospital readmissions for childhood asthma: a 10-year metropolitan study.
Studies of asthma admissions in the St. Louis metropolitan area have disclosed substantial numbers of children with readmissions. To determine the magnitude of readmissions and attributes of children with readmissions, a retrospective analysis of 8,761 children with 14,905 asthma hospitalizations for January 1, 1990 through December 31, 1999 at the two university affiliated children's hospitals in St. Louis was undertaken. Patient attributes of age, sex, race/ethnicity, residence, payor status, length of stay, and month of admission were compared between patients admitted once during that period and patients admitted multiple times. Main outcome measures were the total number of admissions and time to readmission during the study interval. A Lin, Wei, Yang, and Ying model of time to readmission showed that African-American children with Medicaid or no insurance are at higher risk of readmission (risk ratio 1.28) than are African-American patients with commercial insurance or white/other race/ethnicity patients regardless of insurance. Probability of readmission increased from 30% after a first admission, 46% after a second, and 59% after a third. Prior admission was a more specific indicator of readmission with greater positive predictive value than ethnicity or insurance status or their combination.
Adolescent↗
Migrant workers and labor market segmentation in Japan.
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Asia↗
Nutritional quality of meals in nursing homes and meals on wheels for elderly persons in Croatia.
The aim of the study was to evaluate the adequacy of meals provided for elderly residents and non-residents of nursing homes in Croatia. Menus of 44 all-day meals provided for residents from 4 nursing homes and 34 meals on wheels provided for non-residents of low socioeconomic status were selected by random sampling. A questionnaire was used to determine socioeconomic status and attitude of residents (n = 89) and non-residents (n = 80) regarding meals offered. An average energy value of all-day meals and meals on wheels was 96.7 and 39.8% RDA respectively. All-day meals provide adequate amounts of the micronutrients examined (phosphorus, iron, thiamine, riboflavin, niacin and vitamin C) with exception of calcium. Fat provided 35% and 36% of energy for all-day meals and meals on wheels respectively. The body mass index (BMI) under 18.5 kg/m2 had 1.7% residents and 4.0% non-residents. BMI higher than 24.9 kg/m2 were observed in 50% and 47% of residents and non-residents respectively. Gender differences were observed for meal preferences offered to both residents and non-residents. The meals provided adequate amounts of energy and the micronutrients examined. However, a decrease in the energy fraction of fat and decrease in protein content would be advisable.
Aged↗
Survival of patients with cancer of the stomach, colon and rectum, lung and breast in Ragusa, Sicily.
Survival of 1747 patients with cancer of the stomach, colon/rectum, lung and female breast was investigated on incident cases registered by the Ragusa Cancer Registry, covering the Province of Ragusa (275,000 inhabitants) between 1981 and 1986. Cases known from the death certificate only were excluded. Date of death was obtained by a linkage with death certificates issued for Ragusa residents. Living status was assessed directly at the Registrar's Office. Analysis was performed also by sex, age group and presence of histologic verification. Relative survival at 5 years of Ragusa cancer cases was of the same order of magnitude as that observed in the U.S.A. (1980) and in Switzerland (1970-1980). However, the slight differences observed were mostly in favor of the Swiss and American patients. Sex did not significantly influence survival, but younger patients survived longer than older ones. Lack of histologic verification was associated with poor survival.
Age Factors↗
Managing health services: how administrative data and population-based analyses can focus the agenda.
University-based researchers in Manitoba, Canada, have used administrative data routinely collected as part of the national health insurance plan to design an integrated database and population-based health information system. This information system is proving useful to policymakers for providing answers to such questions as: which populations need more physician services? Which need fewer? Are high-risk populations poorly served or do they have poor health outcomes despite being well served? Does high utilization represent overuse or utilization related to high need? More specifically, this system provides decision-makers with the capability to make critical comparisons across regions and subregions of residents' health status, socioeconomic risk characteristics, and use of hospitals, nursing homes, and physicians. The system permits analyses of demographic changes, expenditure patterns, and hospital performance in relation to the population served. The integrated database has also facilitated outcomes research across hospitals and counties, utilization review within a single hospital, and longitudinal research on health reform. A particularly interesting application to planning physician supply and distribution is discussed. The discussion highlights the strengths of integrated population-based information in analyzing the health care system and raising important questions about the relationship between health care and health.
Canada↗
Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005.
BACKGROUND: On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. METHODS: We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. RESULTS: We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. CONCLUSION: Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.
Adolescent↗
Family planning services quality as a determinant of use of IUD in Egypt.
BACKGROUND: Both availability and quality of family planning services are believed to have contributed to increasing contraceptive use and declining fertility rates in developing countries. Yet, there is limited empirical evidence to show the relationship between the quality of family planning services and the population based prevalence of contraceptive methods. This study examined the relationship between quality of family planning services and use of intrauterine devices (IUD) in Egypt. METHODS: The analysis used data from the 2003 Egypt Interim Demographic and Health Survey (EIDHS) that included 8,445 married women aged 15-49, and the 2002 Egypt Service Provision Assessment (ESPA) survey that included 602 facilities offering family planning services. The EIDHS collected latitude and longitude coordinates of all sampled clusters, and the ESPA collected these coordinates for all sampled facilities. Using Geographic Information System (GIS) methods, individual women were linked to a facility located within 10 km of their community. A facility-level index was constructed to reflect the quality of family planning services. Four dimensions of quality of care were examined: counseling, examination room, supply of contraceptive methods, and management. Effects of quality of family planning services on the use of IUD and other contraceptive methods were estimated using multinomial logistic regression. Results are presented as relative risk ratios (RRR) with significance levels (p-values). RESULTS: IUD use among women who obtained their method from public sources was significantly positively associated with quality of family planning services (RRR = 1.36, p < 0.01), independent of distance to the facility, facility type, age, number of living children, education level, household wealth status, and residence. Quality of services related to counseling and examination room had strong positive effects on use of IUD (RRR = 1.61 for counseling and RRR = 1.46 for examination room). Obtaining IUD from a private source or using other contraceptive methods was not associated with quality of services. CONCLUSION: This study is one among the few that used geographic information to link data from a population-based survey with an independently sampled health facility survey. The findings demonstrate that service quality is an important determinant of use of clinical contraceptive methods in Egypt. Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility.
Adolescent↗
Professional ethics of psychologists and physicians: morality, confidentiality, and sexuality in Israel.
Clinical psychologists' and nonpsychiatric physicians' attitudes and behaviors in sexual and confidentiality boundary violations were examined. The 171 participants' responses were analyzed by profession, sex, and status (student, resident, professional) on semantic differential, boundary violation vignettes, and a version of Pope, Tabachnick, and Keith-Spiegel's (1987) ethical scale. Psychologists rated sexual boundary violation as more unethical than did physicians (p less than .001). Rationale (p less than .01) and timing (p less than .0001) influenced ratings. Psychologists reported fewer sexualized behaviors than physicians (p less than .05). Professional experience (p less than .01) and sex (p less than .05) were associated with confidence-violating behavior. Overall, 78% of the sample reported attitudes or behaviors associated with boundary violations. The behavior violations were correlated (r = .49). Actual violators rated vignette violators more leniently than did nonviolators (p less than .01).
Attitude↗
Nutritional status and risk factors for chronic disease in urban-dwelling adults with Down syndrome.
Nutritional status and biochemical risk factors for chronic disease were assessed in 48 community-dwelling adults with Down syndrome in the Chicago area. Dietary intake was measured using a food frequency questionnaire completed by the participant's primary caregiver; anthropometric measures included height and weight and waist circumference. Plasma glucose and lipid concentrations were assessed following a 10-hour fast. Overall, 89% of participants were overweight or obese, 54% had large waist circumferences, and none met the current guidelines for fruit and vegetable intake. Mean concentrations for lipids and glucose, however, were within normal limits; and prevalence for hypertension, elevated lipids, and glucose were less than those for the general population of the United States.
Body Mass Index↗
Out-of-pocket health spending and the rural underinsured.
Multiple studies have documented higher uninsurance rates among rural compared to urban residents, yet the relative adequacy of coverage among rural residents with private health insurance remains unclear. This study estimates underinsurance rates among privately insured rural residents (both adjacent and nonadjacent to urban areas) and the characteristics associated with rural underinsurance. We found that 6 percent of privately insured urban residents were underinsured; the rate increased to 10 percent for rural adjacent and 12 percent for rural nonadjacent residents. Multivariate analyses suggest that rural residents' underinsurance status is related to the design of the private plans through which they have coverage.
Adolescent↗
Urban health: an ecological perspective.
At the Second European Conference on Environment and Health held in Helsinki in June 1994, urban health was attributed a high priority. This decision by the Ministers of Environment and Health from European countries reflects and reinforces a growing worldwide concern in the 1990s about the health status of residents of urban areas in all continents. The reasons for this concern include the rapid rate of urbanization and the increasing number of environmental, economic, and social problems, which have a negative impact on health and well-being in cities. This review presents a theoretical and methodological framework for the study of this vast and complex subject area. The paper proposes and illustrates an ecological perspective by discussing housing conditions and homelessness, as well as the concentration of poverty and deprivation in precise neighborhoods. To promote health and well-being more effectively, the ecological perspective presented in this paper can be applied by public health officers, by urban planners, and by policy decision-makers at national and local levels to promote our understanding of the multi-dimensional nature of health disorders of citizens. This approach should be a high priority for the beginning of the 21st century.
Ecosystem↗
Subgroup differences in drinking patterns among black and white men: results from a national survey.
Despite major increases in alcohol-related health problems and indications of shifts in the cultural role of alcoholic beverages among U.S. blacks, few studies have examined drinking patterns in this population. To address gaps in the literature, data from a 1984 national survey were used to compare drinking patterns and their sociocultural correlates among male, black (n = 723) and male, white (n = 743) Americans. Findings from the survey indicate that, at the aggregate level, black and white men exhibit very similar drinking patterns. The proportion of abstainers, infrequent, frequent and heavier drinkers is very similar for the two groups of men. However, major black-white differences occur when the relationship between drinking rates and major social characteristics is considered. Bivariate tables suggest that frequent heavier drinking among whites is associated with youthfulness, high-income status and residing in "wetter" areas, whereas among blacks these patterns are reversed or absent. Log-linear analysis confirmed some of these findings. When drinking behavior was modeled with respect to race, age, income and region, race emerged as an independent predictor and the effects of age and income varied by race. When the two groups of men were analyzed separately, age and region were the only significant determinants of heavier drinking among whites. Among blacks, income and age emerged as significant variables and the influence of age differed from the findings for whites. The results suggest that there may be important differences in the cultural environments of drinking in black and white men.
Adolescent↗