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PubMed1996

[Apoplexy units--reduced mortality, need for nursing homes, length of stay and cost savings].

Treatment of stroke patients on specialised stroke units has become more frequent, yet the effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment on a stroke unit or a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, prestroke residence, and stroke severity. The patients treated on the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced in-hospital mortality (OR 0.50), case-fatality rate (OR 0.45), 6-month mortality (OR 0.57), 1-year mortality (0.59, and discharge rate to a nursing home (OR 0.61). The relative chance of being discharged to own home was almost doubled (OR 1.9), and the length of hospital stay reduced by 30% in patients treated on the stroke unit, P < 0.001. Treatment of unselected stroke patients on a stroke unit saves lives, nursing homes, and cost.

Cerebrovascular Disorders↗
PubMedDate not supplied

Using diffusion theory in health promotion: the case of tobacco.

Diffusion theory can profitably be applied to a range of health problems and interventions. This paper uses the case of tobacco to illustrate this process. The diffusion of innovations model refers to the spread of new ideas, techniques and behaviours or products throughout populations. Those who adopt at different phases of the process tend to differ in predictable ways, such as age, sex, residence, socioeconomic status and level of access to communications, each of which can be employed to affect the overall rate of adoption. A series of perspectives are employed to examine aspects of the diffusion process for tobacco use. Examples from the tobacco areas are used to illustrate ways in which the diffusion model can be applied in the field. Applications of the model for prevention are presented and discussed.

Canada↗
PubMed1997

Access to health care. Part 2: Working-age adults.

OBJECTIVES: This report presents data on access to health care for U.S. working-age adults, 18-64 years old. Access indicators are examined by selected sociodemographic characteristics including sex, age, race and/or ethnicity, place of residence, employment status, income, health status, and health insurance status. METHODS: Data are from the 1993 Access to Care and 1993 Health Insurance Surveys of the National Health Interview Survey (NHIS), a continuing household survey of the civilian noninstitutionalized population of the United States. The sample contained 61,287 persons in 24,071 households. RESULTS: In 1993, approximately 3 out of 4 working-age adults had a regular source of medical care. Nine out of 10 adults with health insurance had a regular source of care compared with 6 out of 10 adults without health insurance. For adults with a regular source of care, 86 percent received care in a private doctor's office, 9 percent in a clinic, and 2 percent in a hospital emergency room. The two main reasons given for not having a regular source of care were "do not need a doctor" (49 percent), and "no insurance can't afford it" (22 percent). Persons in the highest income group were more likely to report no need for a doctor (59 percent) than persons in the lowest income group (35 percent). About 40 percent of uninsured persons and 16 percent of insured persons reported an unmet medical need. CONCLUSIONS: Health insurance plays a key role in the access to medical care services. Persons who are uninsured or have low incomes are at the greatest risk of having unmet medical needs.

Adolescent↗
PubMed1997

Monitoring pressure ulcers in nursing homes.

Clinical indicators may be used to monitor the quality of care delivery. Unfortunately, they are often viewed by nursing staff as unnecessary paper work. This study used Waterlow's Pressure Sore Risk Assessment Tool as the basis of a clinical indicator to monitor pressure ulcers within a nursing home. It was found that by closely monitoring the skin status of residents, preventative actions could be implemented, thereby minimizing the risk of pressure ulcer development. The advantage of utilizing such a tool is that it is seen to be clinically relevant for nursing staff while providing a bank of data for quality management.

Adult↗
PubMed2005

Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.

OBJECTIVE: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. DESIGN: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. SETTING: All nursing homes in Helsinki community, the capital of Finland. SUBJECTS: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined. RESULTS: One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15). CONCLUSIONS: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

Activities of Daily Living↗
PubMed1995

Care plan assessment of visual status and evaluated vision among nursing home residents.

OBJECTIVE: To compare the comprehensive care plan assessment (Minimum Data Set, MDS) of vision with the clinically evaluated visual status of nursing home residents to determine the accuracy of the vision care plan. DESIGN: Descriptive study. SETTING: One publicly funded and four privately owned long-term care nursing facilities. PARTICIPANTS: 151 nursing home residents undergoing vision examination at the nursing home request. Mean age of 81, range 34 to 97 years. MAIN OUTCOME MEASURE: The charted MDS assessment for vision patterns was compared with the MDS plan which would have been formulated based on direct clinical vision examination. Determinations were made based on the three areas required by MDS: visual acuity (VA), peripheral vision, and presence of prosthetic visual devices. CONCLUSIONS: The MDS care plan for vision and actual visual status agreed in only 34% (52/151) of persons. The Vision (VA) subsection overestimated VA in 41% and underestimated VA in 11%. Concordance for VA was extremely poor (kappa 0.176). In no participants did the MDS indicate a visual field defect, whereas 16.5% (25/151) did show visual field restriction on examination. Care plan assessments also failed to note the use of visual prosthetic devices in 17% (26/151). These results indicate that MDS care plan assessment for vision is often inaccurate and may result in the lack of appropriate vision care being triggered through resident assessment protocols (RAP).

Adult↗
PubMedDate not supplied

Oral and nutritional status--Is the MNA a useful tool for dental clinics.

OBJECTIVES: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents. DESIGN: Descriptive, cross-sectional study. SETTING: All elderly residents in all NH and LT in Helsinki, the capital of Finland. PARTICIPANTS: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53). MEASUREMENTS: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management. RESULTS: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia). CONCLUSION: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

Aged↗
PubMed2004

[Disability due to mental and behavioural disorders in Iceland.].

AIMS: To determine the prevalence of disability in Iceland on December 1st 2002 due to mental and behavioural disorders according to gender, place of residence and marital status and main subcategories. MATERIAL AND METHODS: The disability register of the State Social Security Institute was used to obtain information on the number, gender, age, place of residence, marital status and main diagnosis of recipients of disability pension. From Statistics Iceland the same information was obtained for the Icelandic population between the age of 16 and 66. RESULTS: The prevalence of disability due to mental and behavioural disorders was 2.32% for females and 1.98% for males. For males receiving disability pension the proportion having mental disorders as the main cause of disability was larger than for females. Among females the most common cause of disability was mood disorders whereas among males it was schizophrenia, schizotypal and delusional disorders. Most of those with schizophrenia, schizotypal and delusional disorders in Iceland receive full disability pension. The prevalence of disability due to mental and behavioural disorders was significantly higher in the capital region than in the rest of the country. Marriage and registered co-habitation was considerably less common among recipients of disability pension due to mental and behavioural disorders than among the nation in general. CONCLUSION: The prevalence of disability due to mental and behavioural disorders in the capital region is in excess of what is to be expected from the prevalence of these disorders and from disability in general in Iceland. The relatively high prevalence of disability due to mental and behavioural disorders among males is in line with epidemiological data. The prevalence of disability due to mental and behavioural disorders in Iceland has been rising. This needs to be addressed by improving vocational rehabilitation programs for those suffering from these disorders.

English Abstract↗
PubMedDate not supplied

Functional status and untreated dental caries among nursing home residents aged 65 and over.

This descriptive study examined the relationship between untreated dental caries and functional status among 958 dentate nursing home residents aged 65 and over. Functional status was measured by the Physical Self-Maintenance Scale (PSMS). The PSMS assessment revealed that 32% of subjects were unable to perform all activities, and only 10% could perform all activities. Overall, 59% of subjects had untreated coronal decay and 46% had untreated root decay. In bivariate analysis, untreated coronal and root caries experiences were significantly associated with PSMS limitations, lack of dental care utilization, sex, and number of remaining teeth. Stratified analysis suggested an interaction between functional status and dental care utilization. Among subjects who had received dental care in the preceding year, PSMS status was not significantly related to untreated caries experience; but among subjects who had not received care, PSMS status was significantly related to untreated caries experience. In logistic regression analysis of untreated root decay, a significant interaction was found between PSMS status and dental care utilization. However, in logistic regression analysis of untreated coronal caries, no significant interaction was found; significant independent effects were found for dental care utilization and number of remaining teeth, but not for PSMS status.

Aged↗
PubMed1995

Physician office laboratory education and training in primary care residency programs.

OBJECTIVE: To assess the status of office laboratory residency education and training in family practice, internal medicine, obstetrics and gynecology, and pediatric residency programs. DESIGN: A single mailed survey to 1299 residency programs from December 1992 to February 1993. PARTICIPANTS: Primary care residency directors from 507 (39%) of 1299 programs. INTERVENTIONS: A 27-item survey of residency-based office laboratory practices, education, training, and resources. MAIN OUTCOME MEASURES: Differences between specialties in provision and quantity of office laboratory education and training, presence of a residency-based office laboratory, laboratory classification under the Clinical Laboratory Improvement Amendments, and available laboratory tests. RESULTS: Of those responding, office laboratories were present in 89% of family practice, 19% of internal medicine, 29% of obstetrics and gynecology, and 24% of pediatrics residency programs. Laboratory training was available at 60% of family practice, 16% of internal medicine, 15% of obstetrics and gynecology, and 30% of pediatrics programs. The median number of hours of formal skills training was 10 hours for family practice residency programs but less than 2 hours for the other specialties. Only 25% of the programs reported educational assistance from pathologists. Merely 4% of the programs had postassessment examinations and 2% awarded certificates of achievement. A majority of family practice programs performed waivered tests and physician-performed microscopy tests, but moderately complex tests were performed in less than 50% of family practice programs. CONCLUSIONS: Family practice residency programs provide more office laboratory training for residents than other specialties. There is a need for improved residency training in the basics of office laboratory practice.

Curriculum↗
PubMed2003

The current status of sports medicine training in United States internal medicine residency programmes.

OBJECTIVE: To determine the general status of sports medicine training in internal medicine residency programmes in the United States. METHODS: A cross sectional survey of the programme directors and chief residents of each of the 407 accredited internal medicine programmes listed in the 1999-2000 Graduate Medical Education Directory. RESULTS: The questionnaire was returned by 231 of 404 (57%) programme directors and 233 of 404 (58%) chief residents. A chief and director of the same programme (paired responses) replied from 144 of 404 (36%) programmes surveyed. A formal sports medicine curriculum was reported by 22.1% of programme directors. Programmes with a formal curriculum were 2.9 times more likely to offer any of the sports medicine educational experiences (p<0.0001; Cochran-Mantel-Haenszel). Programmes with block rotations were more likely to include all of the educational experiences surveyed than those without (p<0.002 for each; chi(2) test). A total of 162 programmes included sports medicine as part of other rotations. Most programmes only included sports medicine as part of other rotations: 44.6% (103/231) of all programmes and 63.6% (103/162) of programmes with sports medicine as part of other rotations. Some 29.9% (69/231) of directors reported having an elective, and 3.9% (9/231) reported a required rotation. Almost a quarter (21.7%; 50/231) of directors reported that their residents received no clinical experience in sports medicine. CONCLUSIONS: Little attention is given to the subject of sports medicine when internal medicine residency curricula are developed in the United States. Thus only a small percentage of American internal medicine residency programmes provide significant training in sports medicine.

Clinical Competence↗
PubMed2002

The relationship between admission hemoglobin level and outcome after hip fracture.

OBJECTIVE: To determine the effect of admission hemoglobin level on patient outcome after hip fracture. STUDY DESIGN: Prospective, consecutive. PATIENTS: From July 1991 to June 1997, 395 community-dwelling patients sixty-five years of age or older who had sustained an operatively treated femoral neck or intertrochanteric fracture were prospectively followed up. MAIN OUTCOME MEASUREMENTS: Postoperative complications, in-hospital mortality rate, hospital length of stay, hospital discharge status, place of residence at one year, and mortality and recovery of ambulatory ability and activities of daily living status at three, six, and twelve months. RESULTS: Women with admission hemoglobin levels below 12.0 grams per deciliter and men with admission hemoglobin levels below 13.0 grams per deciliter were classified as anemic. One hundred eighty patients (45.6 percent) were considered anemic on admission. Patients who were anemic were more likely to have an American Society of Anesthesiologists rating of III or IV and have sustained an intertrochanteric fracture. Hospital length of stay and mortality rate at six and twelve months were significantly higher for patients who were anemic on admission. There were no differences in the incidence of postoperative complications, hospital discharge status, place of residence at one year, in-hospital mortality rate, and three-month mortality rate between patients who were and were not anemic on admission. In addition, there were no differences in the recovery of ambulatory ability and of basic and instrumental activities of daily living status at three, six, and twelve months between the two patient groups. CONCLUSIONS: Patients at risk for poor outcomes after hip fracture can be identified by assessing hemoglobin levels at hospital admission.

Aged↗
PubMed2003

Psychiatric resident conceptualizations of mood and affect within the mental status examination.

OBJECTIVE: To explore the ways in which psychiatry residents conceptualize the terms "mood" and "affect," a 14-item questionnaire was sent to residency programs in New York. METHOD: The questions consisted of possible definitions of mood and affect; all questions required a "true" or "false" response. Residents (N=99) were asked how they viewed mood and affect from a temporal perspective (i.e., sustained versus momentary) and in terms of an objective-subjective (or external-internal) dichotomy. RESULTS: There were inconsistencies in the temporal view of mood (said to be sustained by 60.6% and momentary by 50.5%) and affect ("pervasive" by 26.3% and "momentary" by 66.3%). Residents overwhelmingly defined mood as being subjective and internal and affect as being objective and external. CONCLUSIONS: If mood and affect are to be viewed from both perspectives, psychiatrists must infer the enduring internal emotional tone (mood) of a patient over an entire interview.

Affect↗
PubMed2006

A comparison of nonfatal unintentional injuries in the United States among U.S.-born and foreign-born persons.

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000-2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.

Adolescent↗
PubMed2005

Environmental exposure to lead and its correlation with biochemical indices in children.

Lead is a global concern because of its ubiquity in the environment and known to be associated with abnormal neurobehavioral and cognitive development of young children. There is no study from India to describe a composite profile of blood lead and its biochemical influences in children. The present study was aimed at determining the proportion of children with >10 mug/dL blood lead levels (BLLs), association between BLLs, and sociodemographic characteristics, if any, and alterations in biochemical indices in the blood as an underlying mechanism of lead intoxication. A total of 62 children (4--12 y) of Lucknow and nearby areas were recruited to determine BLLs, delta-amimolevulinic acid dehydratase (delta-ALAD) activity, catalase (CAT) activity, and malondialdehyde (MDA) and glutathione (GSH) levels in the blood. Mean level of blood lead was 7.47+/-3.06 microg/dL (2.78--15.0) and 29%-exceeded 10 microg/dL, CDC intervention level. The BLLs were found to be significantly influenced by social status, area of residence, source of water supply, maternal educational status (p<0.001), type of house, and proximity to traffic density (p<0.01). delta-ALAD was significantly lower in the group of children with BLLs 11.39+/-1.39 microg/dL when compared to children with BLLs 7.11+/-1.25 microg/dL and 3.93+/-0.61 microg/dL (p=0.0007, 0.0005, respectively). However, CAT activity was higher in the groups of children with higher blood levels than with lower BLLs (p=0.0159, 0.0001, respectively). There was an increase in MDA level with a concomitant decrease of GSH in children with BLLs 11.39+/-1.39 microg/dL compared with those of children with BLLs 7.11+/-1.25 microg/dL and 3.93+/-0.61 microg/dL (p=0.0001, 0.0002, and p=0.0001, respectively). There was statistically significant correlation of BLLs with delta-ALAD (r=-0.44, p=0.00035), MDA (r=0.46, p=0.00018), GSH (r=-0.62, p=0.00001), and CAT (r=0.44, p=0.00035). Significantly, CAT activity, MDA, and GSH levels were in turn, found to be correlated with delta-ALAD (r=-0.45, p=0.00024; r=-0.43, p=0.00053; r=0.43, p=0.00053, respectively). Results of the present study indicate a declining trend of BLLs in children when compared with those reported from metropolitan cities of India when leaded gasoline was in practice and that the BLLs were significantly associated with biochemical indices in the blood which have the potential to be used as biomarkers of lead intoxication.

Biomarkers↗