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PubMed2004

[Evaluation of indices indicating elderly long-term care need in municipalities].

OBJECTIVE: To establish a way to evaluate preventive care programs using indices that indicate the status of long-term care need for elderly in municipalities. METHOD: Based on the number of people certified as subject to long-term care need and the number of deaths in Taihaku Ward in Sendai City, 3 indices in 14 junior high school districts in the ward were derived; Healthy Life Expectancy for 65 year old men and women (the period in which certification for long-term care need is not made), Hours of Care Need (age-adjusted standard hours for care need) and the Odds Ratio (age-adjusted relative risk) for the elderly aged 65 years or older. Yearly comparisons of the indices were made for 2000 vs 2001, 2001 vs 2002 and 2000 vs 2002. The relationships between the three indices were further analyzed for 2000, 2001 and 2002. Care Compensation by district (age-adjusted care compensation by district was derived for 2001) and its relationships to Healthy Life Expectancy, Hours of Care Need and the Odds Ratio were analyzed by school district for 2001. RESULTS: 1) The Hours of Care Need by district significantly correlated with the Odds Ratios by district for 2000, 2001 and 2002. Both the Hours of Care Need and the Odds Ratio by district also significantly correlated between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002. Healthy Life Expectancy did not show a significant correlation between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002, for men and women. 2) The 2001 Care Compensation by district was obviously proportional to both Hours of Care Need by district and the Odds Ratio by district but did not correlate with Healthy Life Expectancy by district for men and women. 3) Using the co-relationship of the Hours of Care Need between the years, the percentage of applications for certification for care need by people needing care was estimated at 65% for 2000, 87.5% for 2001 and 101% for 2002. This implies that in 2002 almost all the people who needed care applied for the certification. The 2001 Odds Ratio by district was significantly low in district D and significantly high in district H. CONCLUSIONS: Hours of Care Need correlate well with the Odds Ratio and also with Care Compensation which represents long-term care insurance service expenses. The results clearly indicate that the 3 indices represent the status of care need of the elderly in these districts, even with conservative estimates, after 2002. It is suggested that Hours of Care Need and the Odds Ratio are appropriate as indices to evaluate preventive care programs in municipalities.

Aged↗
PubMedDate not supplied

Trends in maternal and infant health in poor urban neighborhoods: good news from the 1990s, but challenges remain.

OBJECTIVES: During the 1990s, numerous public policy changes occurred that may have affected the health of mothers and infants in low-income neighborhoods. This article examines trends in key maternal and child health indicators to determine whether disparities between high-poverty neighborhoods and other neighborhoods have declined. METHODS: Using neighborhood-level vital statistics and U.S. Census data, we categorized "neighborhoods" (Census tracts) as being high poverty (greater than 30% of population below the federal poverty level in 1990) or not. We compared trends in four key indicators--births to teenagers, late prenatal care, low birth-weight; and infant mortality--over the 1990s among high-poverty and other neighborhoods in Cuyahoga County, Ohio; Denver, Colorado; Marion County, Indiana; and Oakland, California. RESULTS: In all four metropolitan areas, trends in high-poverty neighborhoods were more favorable than in other neighborhoods. The most consistently positive trend was the reduction in the rate of teen births. The metropolitan areas with the most intensive programs to improve maternal and child health--Cuyahoga County and Oakland-saw the most consistent improvement across all indicators. Still, great disparities between high-poverty and other neighborhoods remain, and only Oakland shows promise of achieving some of the Healthy People 2010 maternal and child health goals in its high-poverty neighborhoods. CONCLUSIONS: While there has been a reduction in maternal and infant health disparities between high-poverty and other neighborhoods, much work remains to eliminate disparities and achieve the 2010 goals. Small area data are useful in isolating the neighborhoods that should be targeted. Experience from the 1990s suggests that a combination of several intensive interventions can be effective at reducing disparities.

Adolescent↗
PubMed2000

Analysis of some peripheral blood lymphocyte subsets in relation to Borrelia burgdorferi antibodies in patients with Lyme disease.

The aim of our study was to evaluate the changes in T (CD3), B(CD19) lymphocytes, CD4 and CD8 subsets, activated CD3+ HLA-DR+ lymphocytes, lymphocytes with receptor for IL-2 (CD3+CD25), NK cells as well as the rate of CD4/CD8 in 30 patients with recognized Lyme disease, before and after antibiotic therapy. Patients were divided into the following groups: Group I n = 9--without detected specific antibodies against B. burgdorferi and with clinical recognition of EM(erythema migrans). Group II n = 10--with increased IgM production, with a clinical form of Lyme arthritis and neuroborreliosis. Group III n = 11--with increased IgG anti B. burgdorferi production, with clinical recognition of Lyme arthritis. The results were compared with the results obtained in the control group consisting of 90 healthy people. The measurements were performed in the flow cytometer COULTER EPI XL with Becton Dickinson antibodies. The antibodies against B. burgdorferi were detected by means of ELISA method using Dako, Biomedica and Biocom kits. The statistic analysis was performed with AnStat Program. The changes in lymphocyte subsets were characterised by the decrease in the percentage of CD4, CD8, NK and CD3+HLA-DR+ lymphocytes in peripheral blood before treatment with later tendency to increase. The results show that the lag phase of antibodies production coincides with high activity of lymphocytes (group I). The significant level of antibodies in IgM class induced by the collaboration of T and B cells was found in the group II. In the group III, in which antibodies in IgG class predominated, the changes in lymphocyte subsets were less intensive. The results of our investigations indicate that the immune response in Lyme disease develops mainly with the participation of both cellular and humoral response which is involved in both the defense against and the pathogenesis of the disease.

Adolescent↗
PubMed2005

An innovative approach to enhancing the surveillance capacity of state-based diabetes prevention and control programs: the Diabetes Indicators and Data Sources Internet Tool (DIDIT).

The Diabetes Indicators and Data Sources Internet Tool (DIDIT) is an interactive Web-based resource with information on 38 diabetes indicators (e.g., diabetes-associated complications, care, lifestyle) and 12 associated data sources frequently used by state diabetes prevention and control programs. This tool is designed to strengthen the ability of states to conduct diabetes surveillance and to promote consistency in defining and tracking indicators across states. In this way, the DIDIT supports one of the 10 essential public health services: the timely and accurate assessment of public health. In addition to serving as a central repository of information on diabetes surveillance, the DIDIT also allows users to share experiences of using these indicators and data sources in their diabetes surveillance activities, data analysis, and tracking of diabetes-related objectives stated by Healthy People 2010. The DIDIT is an innovative approach to enhancing public health surveillance at the state and national levels.

Delphi Technique↗
PubMed2006

Dietary protein for athletes: from requirements to metabolic advantage.

The Dietary Reference Intakes (DRI) specify that the requirement for dietary protein for all individuals aged 19 y and older is 0.8 g protein.kg-1.d-1. This Recommended Dietary Allowance (RDA) is cited as adequate for all persons. This amount of protein would be considered by many athletes as the amount to be consumed in a single meal, particularly for strength-training athletes. There does exist, however, published data to suggest that individuals habitually performing resistance and (or) endurance exercise require more protein than their sedentary counterparts. The RDA values for protein are clearly set at "...the level of protein judged to be adequate... to meet the known nutrient needs for practically all healthy people...". The RDA covers protein losses with margins for inter-individual variability and protein quality; the notion of consumption of excess protein above these levels to cover increased needs owing to physical activity is not, however, given any credence. Notwithstanding, diet programs (i.e., energy restriction) espousing the virtue of high protein enjoy continued popularity. A number of well-controlled studies are now published in which "higher" protein diets have been shown to be effective in promoting weight reduction, particularly fat loss. The term "higher" refers to a diet that has people consuming more than the general populations' average intake of approximately 15% of energy from protein, e.g., as much as 30%-35%, which is within an Acceptable Macronutrient Distribution Range (AMDR) as laid out in the DRIs. Of relevance to athletes and those in clinical practice is the fact that higher protein diets have quite consistently been shown to result in greater weight loss, greater fat loss, and preservation of lean mass as compared with "lower" protein diets. A framework for understanding dietary protein intake within the context of weight loss and athletic performance is laid out.

Adult↗
PubMed2006

A descriptive study of youth risk behavior in urban and rural secondary school students in El Salvador.

BACKGROUND: Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains-aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors-among public secondary school students in central El Salvador. METHODS: We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12-20 years participated in the study. RESULTS: Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%). CONCLUSION: A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.

Journal Article↗
PubMed2006

New four-pronged approach to wellness combines an eclectic mix of strategies.

Humana uses non-traditional means in an effort to keep seniors healthy. Taking care of people when they're sick is important, but Humana has decided that seniors in particular have a strong interest in maintaining their health, and it is rolling out a new initiative aimed at helping them do just that. The program offers a mix of opportunities related to cognitive function, physical fitness, and nutrition, but there is also a strong component geared toward advocacy. Humana is hoping that the payoff will come in the form of improved health and reduced claims costs.

Community Participation↗
PubMed1988

Benefits of exercise in old age.

Although exercise capacity declines with age, the decline appears to be slight when measured in healthy, physically active subjects. There is growing evidence that exercise has a positive influence on increasing healthy function and decreasing the impact of diseases common in the elderly. While the dose-response relationship between physical activity and health benefits continues to be studied, there is some evidence that even low- and moderate-intensity exercise programs in older people result in tangible improvements in many physical and psychologic parameters.

Aged↗
PubMed2002

Implementation of geriatric education into the first and second years of a baccalaureate-MD degree program.

OBJECTIVE: As the population ages with an increasing standard of good health, medical students must redefine their views on aging and their approaches to aging and medicine. Consequently, the UM-KC School of Medicine has introduced an innovative approach to geriatric education. The approach seeks to help students view aging as a multidimensional process, challenge stereotypes about aging, learn about factors in healthy aging, and explore medical conditions of older patients. DESCRIPTION: To fulfill these objectives, each first- and second-year medical student (n = 200) in a six-year BA-MD degree program is paired with a mentor on aging. The mentor is an older adult living independently and experiencing normal psychosocial issues of aging without major medical problems. Over two years, students converse with their mentors about aging, keep journals reflecting on their conversations, complete projects with their mentors, and write scholarly papers. Thus, students can experience aging through their mentor relationships, gain an appreciation of their mentors' lives, and sharpen communication skills. In small groups, students and a physician-facilitator discuss problem-solving exercises keyed to American Geriatrics Society competencies and participate in an empathic aging exercise. Students also attend lectures on the care of older women and primary prevention. DISCUSSION: Assessment of students' performances is ongoing. Mentors have rated their students positively for being interested in them, being good listeners, and being eager to learn. Facilitators have rated most students highly for small-group participation. Instructors have reviewed and commented on student journals that suggest students have changed their stereotypes about older adults and appreciated the uniqueness of their mentors' lives. A performance-based assessment of the students' abilities to elicit life histories from senior volunteers will be administered halfway into the second year, and the scholarly papers will be critiqued at the end of the second year. Program evaluation is also under way. A pre-test of knowledge and attitudes showed students had little knowledge of the aging process, held negative stereotypes of older people, and preferred to care for younger patients. After-measures will be administered at the close of the second year. Evaluating their experience, mentors have said their interactions with students were enjoyable and beneficial to both parties. Students, while initially hostile because the program shifted their focus from sickly to healthy older adults, have found the evolving bonds between them and their mentors to be a benefit of the program. They believe that the most important lessons learned involved seeing the vitality and courage of older adults and improving their communication skills. Nevertheless, students feel they need more training in leading conversations and conducting interviews. Structured communication training will be added as the program continues to be a required part of the curriculum. Students have also thought the problem-solving cases should be more medically focused. While cases in the second year will emphasize medical aspects of aging, the cases in the first year will continue to explore psychosocial issues. Finally, to highlight psychosocial issues of aging, a session will be added utilizing a panel of older adults to provide examples and insights and to answer questions.

Age Factors↗
PubMedDate not supplied

Pregnancy nutrition surveillance system.

The Pregnancy Nutrition Surveillance System is a useful tool in monitoring Healthy People 2010 objectives and is intended to provide a framework for analyzing data on the nutritional status and behavioral risk factors of pregnant women and the association to birth outcome. The data are useful to health professionals in providing prenatal care and developing programs to reduce pregnancy-related health risks.

Adolescent↗
PubMed1999

Preconditions of language development in deaf children.

The harmful effects of childhood hearing impairment are given little thought by many people because hearing loss is largely an invisible handicap. An infant with a hearing impairment is generally healthy-looking and develops relatively normally during the first year of life. Hearing impairment in infants interferes with the normal development of spoken language. We are biologically programmed to develop certain skills in response to certain inputs. Language learning is one such skill which must be gained very early in life. Hearing is the most important basis for normal language acquisition and language is the keystone of modern society. Hearing loss must be identified as early as possible in the first years of life, especially a child with profound or severe hearing loss must be identified in the first year of life. If not, the child has missed an irreversible sensitive phase for learning of speech and language.

Deafness↗
PubMed2004

Oklahoma and the issue of tobacco.

Tobacco use, particularly cigarette smoking, continues to be the leading cause of preventable morbidity and mortality in the United States. An important public health issue, this has been the focus of much study. Several organizations have issued statements and recommendations for handling this issue. Reducing tobacco use is a key component of Healthy People 2010, the national action plan for improving the health of all Americans. The Surgeon General, Agency for Healthcare Research and Quality (AHRQ) and the U.S. Preventive Services Task Force (USPSTF) have put forth valuable guidelines concerning preventive services in the primary care setting, and programs such as Putting Prevention into Practice (PPIP) and state based initiatives have aimed to implement them. States that have taken these messages to heart and acted upon them to fully implement these preventive measures and interventions have had significant success, most notably Oregon, California and Massachusetts. In less than a decade, the Massachusetts Tobacco Control Program has evolved into one of the leading public health initiatives of our time. Perhaps by learning from their successes we can bring about a similar change in the state of Oklahoma.

Health Promotion↗
PubMed2006

Youth risk behavior surveillance--United States, 2005.

PROBLEM: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. REPORTING PERIOD COVERED: October 2004-January 2006. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity. In addition, the YRBSS monitors general health status and the prevalence of overweight and asthma. YRBSS includes a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education and health agencies. This report summarizes results from the national survey, 40 state surveys, and 21 local surveys conducted among students in grades 9-12 during October 2004-January 2006. RESULTS: In the United States, 71% of all deaths among persons aged 10-24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that, during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol; 18.5% had carried a weapon; 43.3% had drunk alcohol; and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse; 37.2% of sexually active high school students had not used a condom at last sexual intercourse; and 2.1% had ever injected an illegal drug. Among adults aged >/=25 years, 61% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these two causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey; 79.9% had not eaten >/=5 times/day of fruits and vegetables during the 7 days preceding the survey; 67.0% did not attend physical education classes daily; and 13.1% were overweight. INTERPRETATION: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of mortality and morbidity. The prevalence of many health-risk behaviors varies across cities and states. PUBLIC HEALTH ACTION: YRBS data are used to measure progress toward achieving 15 national health objectives for Healthy People 2010 and three of the 10 leading health indicators, to assess trends in priority health-risk behaviors among high school students, and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

Adolescent↗
PubMed1997

The advanced practice nurse role in implementing and evaluating two nurse-managed wellness clinics: lessons learned about structure, process, and outcomes.

By the year 2000, the baby boom generation will be reaching its sixth decade and 34 million U.S. citizens will be over the age of 65. One strategy for promoting healthy aging is having older persons participate in health promotion programs. Nurse-managed wellness clinics (NMWCs) staffed by advanced practice nurses (APNs) offer an option for health promotion among older individuals. This article describes the APN role in implementing and evaluating two NMWCs for older people living in urban, high-rise apartment buildings subsidized by the U.S. Department of Housing and Urban Development. Lessons learned about structure, process, and outcomes in a community-based wellness center are identified and discussed.

Aged↗
PubMed1996

Preventing falls in the elderly at home: a community-based program.

OBJECTIVE: To analyse the effectiveness of an ongoing program for reducing the risk of falls in the elderly in their homes. DESIGN: Retrospective questionnaire survey of the number of falls in the 12 months before home modifications were installed. Participants were followed up 12 months later to determine the number of falls since home modifications. SETTING: Major city, November 1993 to July 1995. PARTICIPANTS: Healthy elderly people recruited at presentations made to gatherings of elderly people about the risks of falls in the home. INTERVENTION: A free home safety inspection and simple home modifications, such as grab-rails and non-slip floor surfaces, were offered at subsidized prices. MAIN OUTCOME MEASURES: Number of falls in the 12 months before and after home modifications. RESULTS: Nearly 4000 elderly people agreed to have a home safety inspection and, of these 90% agreed to have their homes modified. Of the first 305 participants (mean age 74 years) for whom it had been 12 months since modifications 69 (22.6%) had reported having fallen at least once in 12 months before modifications. In the 12 months after modifications, 29 participants (9.5% reported at least one or more falls--a 58% reduction (95% confidence interval [Cl], 37%-72%). The total number of falls decreased from 121 to 45--a 63% reduction (95% Cl, 50%-73%). There was a significant decrease in falls in the 61-65, 66-70, 71-75 and 81-85 years age groups (P< 0.05). CONCLUSIONS: The risk of falling in the elderly can be lowered by more than a half by simple modifications to the home. Behavioural change, as well as environmental change, is important to the success of falls-prevention programs.

Accidental Falls↗
PubMed1999

Three-dimensional kinematics and trunk muscle myoelectric activity in the elderly spine - a database compared to young people.

OBJECTIVE: To establish a database of lumbar spine kinematics and muscle activation profiles for a healthy elderly population. DESIGN: Spine motion parameters and muscle activation profiles of the elderly were identified and quantified in part by comparison with an existing database of younger people. BACKGROUND: Databases are often used as a benchmark to establish what is "normal", or for developing appropriate exercise programs or diagnostic methodologies. METHODS: Twelve people (average age 69 yr) performed full range of motion movements about the flexion, lateral bending and axial twist axes of the lumbar spine. Fourteen torso muscles (7 per side) were monitored with electromyographic electrodes and the signals normalized to maximum voluntary efforts. RESULTS: The elderly were slower moving, and had a reduced range of motion in full flexion and lateral bend but not in axial twist. Furthermore there was more coupled motion evident in the twisting efforts of the elderly. Abdominal muscles appeared to become more active, earlier in the lateral bending movement. CONCLUSIONS: Loss of motion is normal with age together with subtle changes in the way the spine moves and groups of muscles are recruited around the torso. RELEVANCE: Quantification of "normal" changes associated with aging will enable clinicians and scientists to distinguish normal changes from pathology.

Aged↗
PubMed2004

Breastfeeding practices in Colorado businesses.

The Colorado Worksite Infant Feeding Survey was used to examine breastfeeding support policies and practices within Colorado businesses. Only 28.2% of survey respondents reported that their organization provided breastfeeding support services. However, the majority of businesses did offer benefits and services conducive to breastfeeding. There was a low frequency of positive responses related to incentives for increasing the provision of breastfeeding support services. The incentives receiving the highest frequency of positive responses were those related to employer benefits and needs, such as provision of information on successful breastfeeding support programs within similar organizations; provision of information on the benefits of breastfeeding to employers, including cost savings; and availability of tax credits for providing breastfeeding support services. Multiple approaches are indicated for increasing work-site breastfeeding support and for removing barriers to the achievement of Healthy People 2010 breastfeeding objectives for employed mothers.

Adult↗
PubMed2002

A mysterious blood pressure increase in a drilling Naval reservist.

This is a case report of a reservist who presented for a physical examination with hypertension. It was discovered that the reservist was unknowingly taking large doses of Ephedra sinica, or ma huang, a Chinese herbal supplement, for body-building. One of the ingredients in ma huang is ephedrine, an active alpha- and beta-adrenergic stimulant that produces increases in heart rate, blood pressure, and cardiac output. Ma huang has been reported to cause hypertension, hepatitis, nephrolithiasis, and sudden death in healthy, normotensive people. Ma huang will produce a positive urinary drug screen for stimulants and can be a drug of abuse. A recommendation is made to screen for dangerous supplement use before physical readiness training and to stop the supplement for 1 month before beginning any exercise program.

Adult↗