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PubMed1999

Dose-dependent effect of folic acid on the prevention of orofacial clefts.

OBJECTIVE: In 1982, Tolarova(4) found a reduction in the recurrence rate of isolated cleft lip (CL) with or without cleft palate (CP; CL +/- CP) after periconceptional supplementation with a multivitamin including a very high dose (10 mg) of folic acid. The Hungarian randomized, double-blind, controlled trial of periconceptional supplementation with a multivitamin including a physiologic dose (.8 mg) of folic acid did not show any preventive effect on the first occurrence of isolated CL +/- CP and CP. However, the general evaluation of congenital abnormalities in the Hungarian Case-Control Surveillance of Congenital Abnormalities indicated, among others, a reduction of isolated CL +/- CP and CP after the use of high doses of folic acid in the critical period for the development of these congenital abnormalities in the 12-year dataset between 1980 and 1991. We hypothesized that the prevention of orofacial clefts by folic acid has a dose-dependent effect, and this hypothesis was tested in 2 recent Hungarian datasets. DESIGN: In a prospective cohort study, the occurrence of isolated CL +/- CP and CP was studied in the newborn infants born to mothers with or without periconceptional folic acid-containing (.8 mg) multivitamin supplementation. Supplemented women with confirmed pregnancy were recruited from the participants of the periconceptional service. Unsupplemented women were invited to take part in the study after the first visit between the 8th and 12th week of gestation in the antenatal care. Supplemented and unsupplemented women were matched based on age, socioeconomic status, and residence. In contrast, the occurrence of high-dose (in general daily 6 mg) folic acid supplementation was evaluated in the case-control pairs of CL +/- CP and CP, particularly during the critical period of these 2 types of orofacial clefts in the 17 years dataset of the Case-Control Surveillance of Congenital Abnormalities, between 1980 and 1996. Cases were selected from the population-based Hungarian Congenital Abnormality Registry, whereas population controls without congenital abnormality were ascertained from the national birth registry. Two population controls were matched to every case according to sex, week of birth, and district of parental residence. The drug uses, including pregnancy supplements as folic acid, were evaluated based on retrospective self-reported maternal questionnaire and prospective medically documented data of antenatal care logbook. RESULTS: In the prospective cohort study, of 3019 informative offspring (termination of pregnancies in the second and third trimesters because of fetal defect, stillborn fetuses, and liveborn infants) in the supplemented group, 3 had CL +/- CP and 1 was affected with CP, whereas of 3432 informative offspring in the unsupplemented group, 2 had CL +/- CP and 1 had CP. The lack of preventive effect was in agreement with the result of the previous Hungarian randomized double-blind controlled trial; thus, these 2 datasets were combined. The preventive effect of a folic acid containing multivitamin used in the periconceptional period for the first occurrence of isolated CL +/- CP and CP was estimated by the Mantel-Haenszel test. Of 5488 supplemented women, 6 had CL +/- CP, and of 5821 unsupplemented women, 4 had CL +/- CP. Of 5489 supplemented women, 1 had CP, and of 5823 unsupplemented pregnant women, 3 had CP. The Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996, included 38 151 population controls (1.8% of the Hungarian births) and 22 865 cases with congenital abnormalities. Within the latter group, 1368 had isolated CL +/- CP, and 596 had CP. A significantly more frequent use of high-dose folic acid (in general daily 6 mg) supplementation was found in controls than in cases of 1246 case-control pairs of CL +/- CP group and of 537 case-control pairs of CP group, respectively. (ABSTRACT TRUNCATED)

Adult↗
PubMed1997

Comparison of inpatient charges between academic and nonacademic services in a children's hospital.

OBJECTIVE: To compare inpatient hospital charges generated within a children's hospital by academic and nonacademic pediatric services for common medical diagnoses. METHODS: Hospital admissions to a free-standing children's hospital between 9/1/90 and 8/30/94 were selected for patients who were hospitalized 1 to 14 days, with one of six selected diagnoses, and with discharge attending of record either a private pediatrician or an academic subspecialist. Discharge diagnoses, based on ICD-9 codes, included asthma (n = 1983), bronchiolitis (n = 692), gastroenteritis (n = 733), rule out sepsis (n = 1065), urinary tract infection (n = 516), and viral meningitis (n = 288). Charges associated with patient records were dichotomized as above or below the median charge for each diagnostic category. Each category was analyzed separately using a logistic regression model where the dichotomous-dependent variable was charges above the median charge for each diagnosis. Independent variables included physician type, payor status, patient residence, ICD-9 code as primary or secondary diagnosis, patient age, and presence of complicating conditions. RESULTS: By univariate comparison, academic physicians cared for a higher percentage of underinsured patients, and their care was more expensive. Complicated claims were associated with higher charges than uncomplicated claims for all diagnostic categories. Academic and nonacademic physicians were equally likely to generate above-median charges for five of the six diagnostic categories when controlling for confounding factors. A linear regression model in which charge was the dependent variable generated similar results. CONCLUSIONS: Within the same pediatric health care facility, no consistent difference was found between charges incurred on academic vs private inpatient services.

Alabama↗
PubMed2005

Tumor necrosis factor-alpha and involuntary weight loss in elderly, community-dwelling adults.

STUDY OBJECTIVE: To evaluate the association between involuntary weight loss and serum concentrations of tumor necrosis factor (TNF)-alpha in elderly, community-dwelling adults. DESIGN: Cross-sectional, single-time point investigation. SETTING: Two primary care ambulatory clinics. SUBJECTS: Ambulatory adults aged 70 years or older with involuntary weight loss of 2.27 kg (5 lbs) or more, or with stable weight (+/-0.91 kg [2 lbs]) for the 3 months before enrollment. MEASUREMENTS AND MAIN RESULTS: Ten subjects with weight loss (mean+/-SD-4.9+/-2.6 kg) and 25 subjects with stable weight (+0.06+/-0.55 kg) were enrolled. The latter group was recruited to serve as a comparison group to the weight-loss group. Subjects donated a venous blood sample and were administered the Mini Nutritional Assessment at a single clinic visit. Serum concentrations of TNF-alpha were measured by using enzyme-linked immunosorbent assay. The TNF-alpha concentrations were significantly higher in subjects with weight loss (mean+/-SD 19.3+/-24.9 pg/ml) than in subjects with stable weight (mean+/-SD 1.1+/-2.0 pg/ml, p<0.01). No relationship was found between the TNF-alpha concentration and the degree of weight loss expressed as a percentage of total body weight. CONCLUSION: Older adults with involuntary weight loss had increased circulating concentrations of TNF-alpha. Whether TNF-alpha plays a causal role in involuntary weight loss among older adults is unclear; however, this finding is consistent with those in other disease states associated with cachexia. Further research is necessary to clarify this relationship and to determine if pharmacotherapeutic interventions targeted at TNF-alpha can prevent or reverse involuntary weight loss and its associated morbidity and mortality.

Aged↗
PubMed2006

Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans.

OBJECTIVES: We examined associations between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence. METHODS: We used data from the Filipino American Community Epidemiological Survey, a cross-sectional investigation involving 2217 Filipino Americans interviewed in 1998-1999. Multinomial logistic and negative binomial regression analyses were used in assessing associations between unfair treatment and the substance use categories. RESULTS: Reports of unfair treatment were associated with prescription drug use, illicit drug use, and alcohol dependence after control for age, gender, location of residence, employment status, educational level, ethnic identity level, nativity, language spoken, marital status, and several health conditions. CONCLUSIONS: Unfair treatment may contribute to illness and subsequent use of prescription medications. Furthermore, some individuals may use illicit drugs and alcohol to cope with the stress associated with such treatment. Addressing the antecedents of unfair treatment may be a potential intervention route.

Adaptation, Psychological↗
PubMed1980

Characteristics of respondents and non-respondents to a mailed questionnaire.

In establishing a cohort of U.S. nurses, an assessment of response bias was made comparing respondents and non-respondents with regard to age, education, state of residence, employment status, field of employment, and major specialty. Overall, the 122,328 respondents (69.7 per cent) and 43,222 non-respondents were quite similar. Together with the reasonable response rate in a homogeneous population, this suggests that estimation of exposure-disease associations is unlikely to be affected by major bias due to non-response.

Adult↗
PubMed1985

Prevalence and trends in oral contraceptive use in premenopausal females ages 12-54 years, United States, 1971-80.

Data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to estimate the prevalence of oral contraceptive use in the United States, 1976-80. The overall unadjusted prevalence of oral contraceptive use was 16.7 per cent for premenopausal females ages 12-54 years (19.2 per cent for ages 15-44 years). Approximately 8.7 million females (95 per cent confidence interval, 6.9-10.5 million) were oral contraceptive users at the midpoint of NHANES II (March 1978). Comparison to the NHANES I, conducted in 1971-74, indicated a stable number of overall oral contraceptive users in the US population during the 1970s, with shifts in certain age groups: oral contraceptive use increased for females ages 12-19 years and decreased for females ages 20-49 years. The overall age-adjusted prevalences indicated a 2 per cent (95 per cent CI, 0.2-3.8 per cent) decline in oral contraceptive use from the early to the late 1970s. The NHANES provides comparative data and supports findings from another national survey showing a decrease in the per cent of females using oral contraceptives during 1973-82. Trends in oral contraceptive use are also presented by race, poverty level, rural-urban residence, marital status, and education level.

Adolescent↗
PubMed1992

Birthweight distributions in Mexico City and among US Southwest Mexican Americans: the effect of altitude.

In this study birthweight distributions for Mexican Americans and Mexico City were compared. Sharp differences in the two distributions were nearly eliminated by controlling for altitude. The small remaining excess in low birthweight in Mexico City appears to be due to a slight overrepresentation of tertiary hospital deliveries, and possibly to a greater prevalence of pathological conditions. The results are consistent with the favorable low birthweight rate reported for Mexican Americans and illustrate the need to adjust for altitude in studies of low birthweight.

Altitude↗
PubMed2001

All-cause and cause-specific mortality of immigrants and native born in the United States.

OBJECTIVES: This study examined whether US-born people and immigrants 25 years or older differ in their risks of all-cause and cause-specific mortality and whether these differentials, if they exist, vary according to age, sex, and race/ethnicity. METHODS: Using data from the National Longitudinal Mortality Study (1979-1989), we derived mortality risks of immigrants relative to those of US-born people by using a Cox regression model after adjusting for age, race/ethnicity, marital status, urban/rural residence, education, occupation, and family income. RESULTS: Immigrant men and women had, respectively, an 18% and 13% lower risk of overall mortality than their US-born counterparts. Reduced mortality risks were especially pronounced for younger and for Black and Hispanic immigrants. Immigrants showed significantly lower risks of mortality from cardiovascular diseases, lung and prostate cancer, chronic obstructive pulmonary diseases, cirrhosis, pneumonia and influenza, unintentional injuries, and suicide but higher risks of mortality from stomach and brain cancer and infectious diseases. CONCLUSIONS: Mortality patterns for immigrants and for US-born people vary considerably, with immigrants experiencing lower mortality from several major causes of death. Future research needs to examine the role of sociocultural and behavioral factors in explaining the mortality advantage of immigrants.

Adult↗
PubMed2006

Initiation of acetylcholinesterase inhibitors and complications of chronic airways disorders in elderly patients.

BACKGROUND AND OBJECTIVE: Acetylcholinesterase inhibitors (AChEIs), commonly prescribed in Alzheimer's disease, may trigger complications of chronic airways disorders. The aim of this study was to determine whether initiation of therapy with AChEIs contributes to complications of chronic airways disorders in an elderly population. METHODS: Sequence-symmetry analysis was used to assess two cohorts of patients, both with a history of chronic airways disorders. Both cohorts comprised Medicare beneficiaries who received drug coverage through the Pennsylvania Pharmaceutical Assistance Contract for the Elderly, between 1997 and 2002. One cohort of 922 patients initiated treatment with an AChEI; the other cohort of 2819 patients initiated treatment with a beta-adrenoceptor antagonist (beta-blocker), a comparator drug also contraindicated in chronic airways disorders. The occurrence of the following four outcomes in claims data was assessed: (i) emergency room visits for complications of chronic airways disorders; (ii) hospitalisations for complications of chronic airways disorders; (iii) physician visits for complications of chronic airways disorders; and (iv) dispensing of an antibacterial and an oral corticosteroid on the same day. Rate ratios (RRs) were adjusted for age, sex, race, nursing home residence, cognitive status, severity of chronic airways disorders, comorbid illnesses and all other patient characteristics that can be assumed to remain constant over the study period. RESULTS: Initiators of AChEIs had no detectable increased rate of complications of chronic airways disorders. Adjusted RRs of the four outcomes ranged from 1.00 (95% CI 0.61, 1.62; p = 0.99) for physician visits to 1.64 (95% CI 0.55, 4.89; p = 0.37) for emergency room visits, none reaching statistical significance. In contrast, beta-blocker initiators had significantly increased rates of all four outcomes after treatment, with adjusted RRs ranging from 1.97 (95% CI 1.18, 3.29; p = 0.009) for emergency room visits to 2.76 (95% CI 1.71, 4.45; p < 0.0001) for dispensing of an antibacterial and oral corticosteroid on the same day. CONCLUSION: These results suggest that, in current clinical practice, physicians can prescribe AChEIs safely to elderly patients with chronic airways disorders, while beta-blocker prescribing continues to result in adverse health outcomes.

Aged↗
PubMed2002

Infection status of Clonorchis sinensis in residents of Hamyang-gun, Gyeongsangnam-do, Korea.

Oriental liver fluke (Clonorchis sinensis) infection was surveyed among residents of Hamyang-gun, Gyeongsangnam-do, Korea during the period of January 2001 to March 2002. Total 1,041 stool samples were collected from residents who visited Public Health Center and its branches in Hamyang-gun and examined using formalin-ether sedimentation method. The overall egg positive rate was 16%, male showing higher positive rate (21%) than female (10%). The age group of 30 to 50 years had the highest egg positive rate of C. sinensis from 20% to 22%. The positive examinees were treated with praziquantel and educated individually to prevent reinfection. Egg positive rate in this area was decreased when compared with results recorded in the past, however, still remained more than 10%. This study suggests that periodic examination, treatment as well as education of residents should be continued and systematized.

Adolescent↗
PubMed2002

The quality of nursing home care in Taiwan.

This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care.

Activities of Daily Living↗
PubMed2005

[Health behaviors between a health promotion demonstration health center and a general health center].

PURPOSE: The purpose of the study was to compare community residents' perceptions, participation, satisfaction, and behavioral changes between a health promotion demonstration health center and general health center. METHOD: The design of the study was ex-post facto that compared community residents in demonstration health centers and general health centers. The sample included 2,261 community residents who were conveniently selected from demonstration (792 participants) and general health centers (1,496 participants). RESULT: The results of the study were as follows: 1) Perception and participation rates of exercise, nutrition, and hypertension management programs were significantly higher in the participants of demonstration health centers than those of general health centers.; 2) Satisfaction rates of all programs except the smoking cessation program were significantly higher in the participants of demonstration health centers than those of general health centers. However, only the exercise rate among risk behaviors of participants was significantly higher in demonstration health centers than general health centers. CONCLUSION: Systematic efforts for health promotion were effective not only in improving the community's awareness, participation, and satisfaction of the program, but also in changing health behaviors. This evidence should be used to foster and disseminate health promotion programs to other health centers to improve community residents' health status and quality of life.

Adult↗
PubMed2001

Ventilatory capacity indices in Malawian children.

OBJECTIVE: To compare ventilatory capacity indices in healthy Malawian school children with those of other ethnic Africans and Caucasians. DESIGN: Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), FEV1 expressed as a percentage of FVC (FEV%), weight and height. SETTING: Two primary schools in urban Blantyre, Malawi. SUBJECTS: Five hundred and fourteen apparently healthy school children (230 boys and 284 girls) aged six to 17 years. RESULTS: Ventilatory capacity indices (FEV1, FVC and PEFR) strongly and significantly correlated to body size and age of children of both sexes. The mean value of FEV% was 88.3% and it did not change significantly with increasing body size and age of children. The mean values of FEV1 and FVC were 9.8% and 10.8% higher in boys than in girls, respectively. The 1.4% gender difference in PEFR values was statistically non-significant. For FEV1 and FVC values, the average differences between Malawian and European children were between 20.5% and 23% while for PEFR the ethnic difference was about 12%. The Malawian children have similar ventilatory capacity indices to those of Nigerian, Jamaican and Tanzanian children. CONCLUSION: Prediction equations calculated in this study should be used for interpretation of ventilatory capacity indices in Malawian children instead of reference values for Caucasians or ethnic scaling factors. Computation of regional reference values for ventilatory capacity indices shall be continued. It shall embrace additional factors contributing to variance in respiratory functions such as customary physical activity, local environmental conditions, altitude of residence, nutritional status and smoking.

Adolescent↗
PubMed2005

Calcium deficiency and causation of rickets in Ethiopian children.

OBJECTIVE: To assess the role of calcium in the development of clinical rickets among Ethiopian children coming to Jimma Specialised Hospital outpatient, department. DESIGN: Case control study. SETTINGS: Jimma Specialised Teaching Hospital and surrounding urban and rural community in the catchment area. SUBJECTS: One hundred and thirty five under five year old children (30 cases of rickets and 104 non-rachitic cases) who came for paediatric service in Jimma hospital. RESULTS: The mean (+/- SD) level of calcium intake for cases and controls was 664.5 (+/- 102.7) mg and 645.8(+/- 144.4) mg, respectively. There was no statistically significance difference between the two groups in the mean level of calcium intake (t = 0.659, P > 0.05). Generally, in both cases and controls the majority of the study participants were taking calcium below the recommended daily calcium requirement of 800 mg for age group according to Food and Nutrition Board of the National Research Council. When adjusted for different co-variates including age, sex, breast feeding history, history of diarrhoea lasting longer than 14 days and 24 hours calcium intake children and religion, occupation, educational status and residence the mothers/care givers using logistic regression model, frequency of exposure to sunlight ( OR = 1.55, 95%CI: 1.2, 2.0), being from rural areas (OR = 5.0, 95% CI: 1.1, 23.3) and age 12-23 months (OR= 4.5, 95% CI: 1.2, 16.5) were significantly associated with rickets (P < 0.05). CONCLUSION: It was found that Ethiopian children with rickets and without had a low calcium intake as compared to the recommended daily allowance. The fact that there was no difference in the dietary calcium intake between cases and controls and the significant difference observed between case and controls in terms of frequency of exposure to sunlight per week reflects that vitamin D deficiency emanating from poor exposure to radiant energy is the main cause of rickets in Ethiopian children. This study also documented the fact that rural children are at a higher risk of developing rickets as compared to their urban counterparts which could be mainly due to the traditional beliefs and practices more prevalent in the rural areas. Enhancing behaviour change communication about the benefits of exposing children to sunlight is very important in preventing the prevalence of rickets.

Adolescent↗
PubMed2005

Rates of percutaneous coronary interventions and bypass surgery after acute myocardial infarction in Indigenous patients.

OBJECTIVE: To compare rates of percutaneous coronary interventions (PCI) and bypass surgery after acute myocardial infarction (AMI) in Indigenous and non-Indigenous patients. DESIGN: Cohort study of public-sector patients who were followed up for 1 year using administrative hospital data. PARTICIPANTS AND SETTING: We followed up 14 683 public-sector patients admitted to Queensland hospitals for AMI between 1998 and 2002. Of these, 558 (3.8%) identified as Indigenous. OUTCOME MEASURES: Rates of PCI and bypass surgery, adjusted for differences between the Indigenous and non-Indigenous cohorts according to age, sex, socioeconomic status, remote residence, hospital characteristics, and comorbidities. RESULTS: The adjusted rate for PCI during the index admission was significantly lower by 39% (rate ratio [RR], 0.61; 95% CI, 0.38-0.98) among Indigenous versus non-Indigenous patients with AMI; the adjusted rate for subsequent PCI was significantly lower by 28% (RR, 0.72; 95% CI, 0.54-0.96). Adjusted rates for bypass surgery were similar in the two cohorts. For any coronary procedure (ie, PCI or bypass surgery), the adjusted rate was significantly lower by 22% (RR, 0.78; 95% CI, 0.64-0.94) among Indigenous patients with AMI. Diabetes, chronic renal failure, pneumonia, and chronic rheumatic fever were at least twice as common among Indigenous patients with AMI as in the rest of the cohort, and chronic bronchitis and emphysema and heart failure were at least 60% more common. If a patient had at least one comorbidity, then their probability of having a coronary procedure was reduced by 40%. CONCLUSIONS: There are likely to be several reasons for the lower rates of coronary procedures among Indigenous patients, but their high rates of comorbidities and the association of comorbidities with lower procedure rates was an important finding. As investment in primary care can reduce the prevalence and severity of comorbidities, we suggest that adequate primary health care is a prerequisite for effective specialist care.

Adult↗
PubMed1983

Long term care facilities: the benefits of having a dietitian.

This article describes the improvements made by a dietitian in two long term care facilities. Neither facility had previously employed a dietitian. Nutritional status of residents was improved by menu revisions that included more dairy products. Accurate serving of calculated diets was instigated. Administrative tools such as policy and procedure manuals and standardized recipes were introduced. It is to be hoped that the positive experiences of these long term care facilities in employing dietitians will encourage other facilities to follow suit.

British Columbia↗
PubMed1992

Great Expectations: Overview of Adolescent Nutrition for the Year 2000 and Beyond.

Although in many respects American adolescents have never been healthier than they are today, expectations for future improvements must take into account cultural factors such as socioeconomic status, rural residence, and ethnic identity as well as specific issues associated with pregnancy, chronic illness, and eating disorders. Public health policy must address these concerns on the local, state, and federal levels.

Journal Article↗
PubMed1998

[Protein status and antioxidant capability of residents in endemic and nonendemic areas of Keshan disease(KD)].

From a survey of residents in endemic and nonendemic areas of Keshan disease(KD), it was found that the plasma cystine, tryptophan and lysine as well as blood selenium content were lower, while the plasma lipid peroxide was higher in endemic areas than those in non-endemic areas. These results suggests that the selenium deficiency coexisting with cystine and tryptophan insufficiency decreases the antioxidant defense of the organism and may be one of the important factors for the development of KD. The role of sulfur-containing amino acid in antioxidant defense is discussed emphatically.

Adult↗