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PubMed1999

Secular trend in age at menarche in China: a case study of two rural counties in Anhui Province.

There is increasing evidence that age at menarche has decreased in Europe and the United States during the last century and in Japan over the last several decades. Data from a community-based survey conducted in two rural counties of Anhui Province in China indicate a similar, downward secular trend in age at menarche for Chinese women. The present study shows the mean age at menarche decreased by 2.8 years, from 16.5 to 13.7, over an approximate 40-year time interval. This rapid decrease in age at menarche may partly be due to better nutrition and living standards reflected by the improved socioeconomic standards experienced in China over the past few decades. To test this hypothesis, a number of determinants of age at menarche were assessed; year of birth, literacy status, county of residence, amount of physical labour, general health status, pesticide exposure before age at menarche, and drinking water source were all found to be associated with age at menarche.

Adolescent↗

PubMed1979

The quality of verbal interaction in homes for old people.

Some 4,500 verbal exchanges among residents, and between staff and residents were recorded during structured observations in eight British purpose-built Homes for old people. These interactions were initially categorised as 'supportive/acceptive' or as 'other'. Subsequently, the 'other' data from four of the Homes was further classified as 'instrumental' and 'unclassifiable'. The participants in the exchanges were noted (resident or staff) as was the mental status assigned to residents ('confused' or 'rational'). The data suggest that interactions among residents are more likely to be supportive/acceptive than are those between staff and residents; that, similarly, interactions among rational residents are more likely to be supportive than those between rational and confused residents, or than those among confused residents. Interactions between rational and confused residents are more likely to be supportive than those among confused patients. Further, the data indicate that interactions between staff and rational residents, and between staff and confused residents do not differ in quality; predominantly, interactions between staff and residents are instrumental. These interpretations of the data are discussed in relation to the care of residents in institutional settings.

Aged↗

PubMed1981

The relationship between drinking patterns at therapy termination and intake and termination status on social variables: a replication study.

The interpersonal support, residence, and employment status of 198 alcoholics were assessed both at intake and at therapy termination. At question was the comparative strength of association between the social status variables when assessed at intake versus termination with drinking patterns at termination of therapy. Results indicated the magnitude of association was very high for termination social variables and minimal to nonexistent for intake social variables. The study was replicated with a group of 171 alcoholics with virtually identical results. The implications of these results for assessing alcohol treatment outcomes are discussed.

Alcohol Drinking↗

PubMed2004

Tuberculin reactivity and tuberculosis epidemiology in the Pakaanóva (Wari') Indians of Rondônia, south-western Brazilian Amazon.

OBJECTIVE: To investigate the characteristics of tuberculin skin test reactivity in the Pakaanóva Indians, in Amazonia, Brazil, after revaccination of all study participants with bacille Calmette-Guerin (BCG). METHODS: The investigation was designed as a post-BCG vaccination purified protein derivative (PPD) survey. Data included PPD readings, age, sex, nutritional status, place of residence, previous tuberculosis, physical examinations and BCG status. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: About 90% (n = 505) of the total population participated. One third (32.1%) of the subjects presented induration > or = 10 mm at 72 h. Induration sizes showed weak linear correlation with age; differences between sexes were not observed. Skin reaction was not associated with nutritional status. Individuals with a history of tuberculosis were six times more likely to test positive. History of tuberculosis, age, and previous BCG vaccination were significantly associated with PPD reactivity in the multivariate analyses. CONCLUSION: The Pakaanóva showed a high proportion (58.4%) of non-reactors, even with a recent BCG booster. Sex differences in PPD reactivity were either not present or could not be demonstrated. The association between age and PPD reactivity resembles that observed in other Amazonian populations. The authors discuss the potential of PPD testing as a screening tool to enhance tuberculosis detection, especially in indigenous populations in Amazonia with limited access to health services.

Adolescent↗

PubMedDate not supplied

Socio-economic determinants of age differences between spouses in Bangladesh.

"This study examines socio-economic differentials in age differences between spouses in Bangladesh. The variables considered for the analysis are bride's current and childhood residences, education, work status before and after marriage; and groom's childhood residence, education and occupation. Among these variables, childhood residence, education and occupation evince the strongest differentials." (SUMMARY IN FRE AND ITA)

Age Factors↗

PubMed1990

Dental health status and treatment needs of elderly residents of Edmonton, Alberta.

The oral health of 140 independent elderly volunteers, selected from different sections of Edmonton, Alberta, was assessed in conjunction with their nutritional and medical status, in an attempt to evaluate the dental needs of this population. Dental caries was assessed using WHO standards and the CPITN was used in assessing periodontal and gingival health needs. The mean age of the participants was 70.9 +/- 2.6 years. The average time since they had last seen a dentist was 3.0 +/- 6.2 years. Twenty-six percent of the group were edentulous and wore full dentures. An evaluation of denture hygiene and retention showed that 53 per cent of all maxillary and 57 per cent of all mandibular appliances exhibited poor hygiene; 33 per cent and 54 per cent, respectively, had problems with retention and/or occlusion. Only 12 per cent of the group exhibited any sort of mucosal pathology, all of which was related to ill fitting dentures. The total population had a mean of 15.0 +/- 11.1 teeth, only 0.5 of these were decayed, while 8.9 were restored. CPITN scores taken from a total of 511 sextants with standing teeth showed that 16 per cent of the group exhibited bleeding upon probing, 29 per cent had calculus, 13 per cent exhibited pocketing, while 3.6 per cent had deep pockets. Sixty-seven per cent of the population required dental treatment, none of whom needed emergency intervention. Over 49 per cent of the dentate population could benefit from prophylaxis; 16 per cent required more definitive periodontal treatment. Forty-five per cent of the denture population required treatment.

Aged↗

PubMed2003

Comparison of urban and rural non-fatal injury: the results of a statewide survey.

OBJECTIVES: This study compared the epidemiology of non-fatal injury among urban and rural residents of Colorado. DESIGN: A stratified probability sample with random digit dial methods was used to survey Colorado residents by telephone regarding injuries experienced in the last 12 months. Questions on the cause of the injury, the activity at the time of the injury, and the place of injury were based on the Nordic Medico Statistical Committee's (NOMESCO) classification of external causes of injuries. SUBJECTS: A total of 1425 urban and 1275 rural Colorado residents aged 18 and older were interviewed. RESULTS: Age, gender, marital status, and rural residency were found to increase the odds of self reported injury. The adjusted odds ratio for self reported injury was 1.3 (95% confidence interval (CI) 1.01 to 1.68) for rural compared with urban residents. Rural residence (odds ratio 1.02, 95% CI 0.51 to 7.01) was not a risk factor for injury among the highest risk group, those who were single and never married. No differences in injury characteristics were found by urban-rural status. CONCLUSIONS: The increased odds of self reported injury among rural residents were not explained by differences in the causes of injury or other injury characteristics. The differences in the importance of rural residence in increased odds of injury by marital status warrants further understanding and may be important in the development of injury prevention programs. Based on comparison with a similar survey, the NOMESCO coding system appears to be a viable alternative survey tool for gathering information on injury characteristics.

Adolescent↗

PubMed1995

The relationship of health professional shortage areas to health status. Implications for health manpower policy.

OBJECTIVE: To compare the health status of adult residents of health professional shortage areas (HPSAs) with adult residents of non-HPSAs. DESIGN: A random-digit dialing telephone survey. Respondents were subsequently classified by their county of residence as residing in an HPSA or non-HPSA. PARTICIPANTS: A sample of 470 adults (18 years or older) living in Kentucky. MAIN OUTCOME MEASURES: Health status was measured by the Medical Outcomes Study 20-Item Short-Form Health Survey's six subscales. RESULTS: Controlling for demographic variables in the multiple regression analysis, there were significant differences between HPSAs and non-HPSAs for the social, mental health, and pain subscales. An interaction between age and HPSAs in relation to health status was observed for the physical, social, mental health, health perception, and pain subscales. After stratification by age (18 to 44 years, 45 to 64 years, or 65 years or older), HPSA-designated areas were associated with poorer health status in all but the youngest age strata. Elders in HPSAs had the poorest health status. CONCLUSIONS: Health professional shortage areas are associated with poorer health status in the older segments of the adult population. Future policy may need to focus on increasing access not only to primary care services but also to specific types of services that may promote better health status of elderly residents of HPSAs.

Adult↗

PubMed2006

[Anesthesia practice in Catalan hospitals and other health care facilities].

BACKGROUND AND OBJECTIVE: The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. PATIENTS AND METHOD: We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. RESULTS: A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. CONCLUSIONS: The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

Adult↗

PubMed1994

Finnmark Heart Study: employment status and parenthood as predictors of psychological health in women, 20-49 years.

This study examined the influence of employment status and presence of young children in the household on psychological health in a population-based sample of 3103 women aged 20-49 years. Women were classified by employment status and parental status, thus creating four groups for comparison. After excluding women reporting chronic diseases and women receiving sickness, rehabilitation, unemployment or disability benefits, analyses indicated that problems of coping, dissatisfaction with life, depression and loneliness were greatest among homemakers, particularly among those with young children. Analyses adjusted for age, education, marital status and place of residence yielded similar results. Stratification by marital status and place of residence revealed two exceptions to this general pattern: unmarried employed women with young children had the highest rate of coping problems--and parenthood, not employment status, was the most important factor for psychological health problems in rural areas. Discrepancies between an individual's behaviour and the norm in society regarding women's employment, may partly explain the findings.

Adaptation, Psychological↗

PubMedDate not supplied

Impact of family visits on agitation in residents with dementia.

In an investigation of the impact of family visits on the behavior of 30 residents in dementia special care units, we found on direct observation that agitation decreased significantly during visits, but returned to the previous level within 30 minutes. No significant differences were found between visits by spouses or adult children. The premorbid quality of relationship was unrelated to family visitor enjoyment of visits or to differences between agitation level before and after visits. While 70 percent of visitors reported that they found visits pleasant (mean number of visits: 12.72 per month), 20 percent found visits unpleasant. Visitors' enjoyment or displeasure was significantly related to the difference between the number of pre-visit and post-visit agitated behaviors. Visitors indicated that the resident's mental status (33 percent) or difficulty communicating with the resident (30 percent) had the most negative impact on their visits. However, these factors appear amenable to education, suggesting that the quality of visits can be improved for visitor and resident with possibly greater positive impact on both.

Adaptation, Psychological↗

PubMed1991

[Effect of student knowledge in gastronomy schools and origin of residence on their nutritional habits and nutritional status].

Nutritional habits and nutritional status of 142 pupils of a Gastronomic School Complex were examined from the standpoint of the year of school, school marks and place of residence. It was found that the year of school and place of residence exerted an effect on the nutritional habits of pupils. These young people failed to prefer dishes and food products recommended in the prophylaxis of civilization diseases. In all subjects the levels of total lipids and beta-lipoproteins exceeded the upper range of the norm. Hemoglobin concentration fluctuated within the lower range of the norm, and that of glucose--within the upper range of the norm. When completing school, the pupils displayed a lowered protein level and elevated glucose level. Pupils inhabiting the school boarding house ought to take part in the decisions on the menu and on food purchases. Recommendations concerning nutrition in the prophylaxis of civilization diseases ought to be as soon as possible introduced into the teaching program of the Gastronomic School Complex.

Feeding Behavior↗

PubMed1994

The status of implant training in oral and maxillofacial surgery residency programs.

PURPOSE: The results of a survey concerning the status of oral and maxillofacial surgery resident training in oral implantology are discussed. RESULTS: The results demonstrate that oral and maxillofacial surgery residents are exposed to a variety of implant types and systems, with most implant surgery being performed in association with intravenous sedation. The number of implants placed by each resident during training varied greatly. CONCLUSION: Most program directors believe that the implantology training of oral and maxillofacial surgery residents is superior or comparable to that of periodontal graduate students. However, this survey suggests that certain aspects of residency training in implantology, such as the performance of sinus lift procedures and participation in implant research, may require more emphasis.

Clinical Competence↗

PubMed2004

Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making.

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral.

Australia↗

PubMed2003

Economy, community and mortality in British Columbia, Canada.

Stimulated by the growing body of literature relating economic inequalities to inequalities in health, this article explores relationships between various economic attributes of communities and mortality rates among 24 coastal communities in British Columbia, Canada. Average household income, a measure of community wealth, was negatively related and the incidence of low incomes, a measure of poverty, was positively related to age-standardized mortality. Both were more strongly related to female than male mortality. Mean and median household income, the incidence of low incomes and a lack of disposable income, and the proportion of total income dollars derived from government sources were significantly related to mortality rates for younger and middle-aged men but not for elderly men. Mortality rates for younger and middle-aged women were not explicated by these economic attributes of communities: among elderly women only, mortality rates were higher in communities with a lower average household income and in those with a higher incidence of low incomes. Finally, a higher concentration in white-collar industries was related to higher mortality rates for females, even after controlling for other economic attributes of communities. These results do not obviously support a psychosocial argument for an individual-level relationship between income and health that assumes residents perceive their status primarily in relation to other members of the same community, but do provide moderate support for the materialist argument and moderate support for the psychosocial argument that assumes community residents perceive their status in relation to an encompassing reference group. Other viable interpretations of these relationships pertain to ecological characteristics of communities that are related to both economic well-being and population health status; in this instance, concentration in specific economic industries may help to understand the ecological relationships presented here.

Adolescent↗

PubMed2003

Mortality and functional outcomes of pelvic insufficiency fractures in older patients.

OBJECTIVE: To evaluate 1-year mortality and functional outcomes after pelvic insufficiency fractures in older patients. PATIENTS AND METHODS: Retrospective review of medical records of patients 65 years of age or older admitted to our geriatrics department for pelvic fracture related to bone insufficiency over a 10-year period (1990-1999). For each patient, we recorded the circumstances of the fracture, time to diagnosis and imaging studies needed for diagnosis, functional status, place of residence before and after the fracture, general health status, treatment, short-term outcome, complications if any, length of hospital stay, and 1-year outcome. RESULTS: Sixty patients (54 women and 6 men) with a mean age of 83 +/- 7.1 years had 49 pubic rami fractures, 16 sacral fractures, and three acetabular fractures. The sacral fractures were usually found only by radionuclide bone scanning, so that time to diagnosis was longer. A history of fracture or risk factor for fracture was found in 45% of the patients. One patient died during the hospital stay. No thromboembolic events were recorded. Twenty-four patients experienced other intercurrent events (urinary retention, lower respiratory tract infection, or urinary tract infection). Mean hospital length of stay was 45 +/- 28 d overall and was longer in the subset of patients who were not fully self-sufficient before the fracture. At discharge, 50% of patients had not recovered their former level of self-sufficiency and 25% had to be institutionalized. The 1-year mortality rate was 14.3%. Pelvic insufficiency fractures are common in older patients. Although they are rarely life threatening, they deserve special attention as a source of functional disability.

Aged↗

PubMed2000

The prevalence of methicillin-resistant staphylococcus aureus among the residents of six nursing homes for the elderly.

Admissions to Irish hospitals from nursing homes are recognized as a high-risk category for methicillin-resistant Staphylococcus aureus (MRSA) colonization. This study was conducted between August 1994 and May 1995 to determine the prevalence of MRSA within six Eastern Health Board elderly care nursing homes. A point prevalence survey was conducted in each home on two separate occasions at an interval of five to six months. An MRSA prevalence rate of 8.6% (65 of 754 residents) was recorded for the first survey, and an increased prevalence rate 10.1% (75 of 743 residents) for the second. The prevalence rates within individual homes varied from 1-27%. The body site most commonly colonized was the nares (83%), as anticipated. The main unexpected finding was a low wound colonization rate of 12%, which increased to only 20%, among MRSA positive residents. The dynamic state of MRSA colonization within nursing homes was documented among the 587 residents screened in both surveys. The MRSA positive status of 19 residents remained unchanged, but 32 who were initially positive became negative, while 34 residents acquired the organism. Twenty-six of the 56 (46%) residents identified as MRSA positive in the second survey had acquired the organism within the nursing home over the preceding five to six months. These findings suggest that 'infection control' interventions could have a significant impact on MRSA prevalence within nursing homes.

Aged↗

PubMed1997

Oral health status and related behaviours of U.S. nursing home residents, 1995.

SETTING: The 1995 U.S. National Nursing Home Survey. AIMS: A descriptive overview of reported oral health status and related behaviours for residents. DESIGN: Cross-sectional survey. SUBJECTS: 8,056 residents. INTERVENTION: Interviews by knowledgeable staff, examination of charts and/or personal knowledge. MAIN OUTCOME MEASURES: Information on the overall condition of oral health, edentulous status, presence/absence of dentures, difficulty chewing or biting, dental care received in past month, and method of payment for dental services in addition to personal characteristics and medical information. RESULTS: Fifteen percent of the residents were described as having excellent or very good oral health. Forty-one percent of the residents had difficulty chewing and biting. Almost one half of nursing home residents (47%) were totally edentulous. Twenty-six percent of residents had dental services paid for during the past month. Nursing home residents have multiple known barriers to oral health: ability to pay, extended periods of time without direct access to the dental care delivery system, and serious chronic medical conditions. CONCLUSIONS: There are serious deficiencies in achieving one of the US national health objectives: ensuring adequate oral health care for institutionalized individuals.

Aged↗