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PubMed2004

Influenza vaccination by race among disabled community dwelling older women.

Disabled older adults have been shown to be at risk for underutilization of some preventive services relative to able-bodied individuals. The Women's Health and Aging Study surveyed female Medicare enrollees in Baltimore, Maryland, who were among the most disabled community-dwelling women at the start of the study. Longitudinal survey data from the study were used to test for the existence or emergence of racial variation in influenza vaccination rates, for which racial variation has been shown in the general population. The primary analysis, using data on the same women before and after Medicare flu shot coverage began, suggested that influenza vaccination rates increased after Medicare coverage began and that there was no difference by race. A secondary analysis using data on women who were interviewed only after Medicare flu shot coverage began showed some racial variation, although the difference may have been larger prior to coverage. The utilization rate did not approach the Healthy People 2010 target.

Aged↗
PubMed1992

Is dental education in step with current geriatric health promotion initiatives?

As dramatic changes in U.S. society continue to stress our health care system, we must consider new strategies to meet the oral health needs of older individuals. Several recent national initiatives, including the Healthy People 2000 health objectives and the Surgeon General's Workshop on Health Promotion and Aging, provide measurable health objectives and suggestions for educational activities in the area of geriatric oral health promotion. Using these and other recent documents like "Practitioners for 2005, An Agenda for Action for U.S. Health Professional Schools," we can evaluate current educational programs in geriatric dentistry, as well plan programs and health promotional activities that meet the future needs of dental professionals and the patients they serve.

Aged↗
PubMedDate not supplied

Is a family history of diabetes associated with an increased level of cardiovascular risk factors? Studies in healthy people and in subjects with different degree of glucose intolerance.

In order to evaluate whether the presence of a positive family history of diabetes (PFH) may have a negative impact on both glucose metabolism and cardiovascular risk factors, we studied parameters of carbohydrate metabolism (fasting and 2h-plasma glucose, HbA1c) and beta-cell function (fasting insulin and C-peptide), as well as the levels of some established cardiovascular risk factors (total cholesterol and triglycerides, HDL-cholesterol, blood pressure) in 729 subjects who were seen within the frame of a Regional Health Program in Taranto, South Italy. According to the NDDG criteria, 147 men and 235 women had normal glucose tolerance, 54 men and 66 women non-diagnostic OGTT, 65 men and 79 women impaired glucose tolerance, and 45 men and 58 women newly-diagnosed Type 2 diabetes. There was a continuous increase of PFH across the categories of glucose intolerance (p < 0.001). Subjects with PFH were younger (4 years on the average) than subjects without PFH. After adjustment for age, there was no difference in the clinical and metabolic parameters considered across the categories of glucose tolerance between subjects with or without PFH. Only in OGTT-diagnosed diabetics, was the presence of PFH associated with significantly greater levels of total cholesterol and 2h-plasma glucose, as well as a trend for triglycerides and HbA1c to be higher. There was a continuous increase in fasting glucose, HbA1c, insulin and C-peptide across the categories; however, the C-peptide/insulin molar ratio was lowest in OGTT-diagnosed diabetics. There was a graded and significant increase in the levels of cardiovascular risk factors across the categories.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

[Analysis of the Educational Program for Self-Care in the Elderly (PECA) for improving the quality of life of the elderly].

OBJECTIVE: To determine the efficacy over 12 months of the educational programme on self-care of the elderly (PECA), which covers quality of life, nutritional status, and perceived social support of people over 65 living in their own homes. DESIGN: Pre-test/post-test experimental study with control group. SETTING: Urban population in the Manso Health District (Example, Barcelona), Spain. PARTICIPANTS: Persons over 65 living in their own homes, healthy or with chronic illnesses characteristic of their age, who had a normal score in the Pfeiffer test. A total of 70 subjects (35 per group) were selected and 5 of the control group left the study. INTERVENTION: Programme on self-care of the elderly, including education on physical activity, nutrition, and social support. MEASUREMENTS: Dependent variables were quality of life, measured by the Nottingham Health Profile; nutritional status, measured by the Mini-Nutritional Assessment (MNA); and social support, measured by the Duke-Unk Functional Social Support Scale. RESULTS: The study sample had an average age of 70.9 (SD, 3.1); 88.2% had self-perception of good health; and 21% lived alone. We only found statistically significant differences between pre- and post-intervention observations in nutritional status (P=.001). CONCLUSION: Despite a statistically significant difference in the variable of nutritional status, the difference was not "clinically" relevant. The ineffectiveness of the intervention is due to our starting from a very homogeneous sample, which had good health status and well-established social networks.

Aged↗
PubMed1999

Quality of health care for people with developmental disabilities: the challenge of managed care.

Health care quality issues for people with developmental disabilities under managed care were explored. Health-related quality was defined in terms of four domains: structure, process, outcome, and satisfaction. Three general problems in the assessment of health care quality were identified: lack of quality measures, patient response problems, and lack of system elements. Selected current measurement systems were described in relation to their use for people with developmental disabilities. An approach to developing quality measures was outlined using Healthy People 2000, Health Plan Employer Data Information Set, and clinical practice issues. The movement toward quality improvement was examined and recommendations presented for steps in developing and measuring health care quality.

Forecasting↗
PubMed2003

Cancer-related health behaviors and screening practices among Latinos: findings from a community and agricultural labor camp survey.

OBJECTIVE: To examine whether cancer-related health behaviors and screening practices differ within a population of Latino adults, including those often missed by cancer surveys. DESIGN: Cross-sectional survey, conducted in 2000. Sample of 461 women and 356 men from the community (75% with unlisted telephones) and 188 men from agricultural labor camps, 18-64 years of age. SETTING: Monterey County, California. OUTCOMES: Six health behaviors and risk factors: obesity, poor nutrition, physical inactivity, high alcohol use, and smoking. Five health practices and screening tests used to detect cervical, breast, and colorectal cancer. RESULTS: Most respondents were born in Mexico, spoke Spanish, and had lived in the United States 10 years or more. In both surveys, more than 60% were overweight including more than 20% who were obese. Men, especially from labor camps, reported high dietary fat intake, low fruit intake, and high alcohol use. For every additional 5 years lived in the United States, the odds of obesity increased 25% for women, and the odds of high-fat/fast food intake and high alcohol use increased 35% and 50%, respectively for labor camp men. Screening rates for cervical and breast cancer were high and met Healthy People 2000 objectives. In contrast, screening rates for colorectal cancer were low; among those 50 and older, approximately 70%-80% of women and men from the community sample and 100% of men from the labor camp sample had never had a blood stool test. Unmarried women, in particular, had poor nutrition and low screening rates. CONCLUSIONS: Cancer control programs for Latinos need a particular focus on weight, nutrition, physical activity, alcohol, and colorectal screening.

Adolescent↗
PubMed2005

[Relationship between C-reactive protein and features of the metabolic syndrome in military pilots in the Serbia and Montenegro].

BACKGROUND/AIM: C-reactive protein is an independent predictor of the risk of cardiovascular events and diabetes mellitus in apparently healthy men. The relationship between C-reactive protein and the features of metabolic syndrome has not been fully elucidated. To assess the cross-sectional relationship between C-reactive protein and the features of metabolic syndrome in healthy people. METHODS: We studied 161 military pilots (agee, 40 +/- 6 years) free of cardiovascular disease, diabetes mellitus and active inflammation on their regular annual medical control. Age, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, fasting glucose, glycosylated hemoglobin, blood pressure, smoking habit, waist circumference and body mass index were evaluated. Plasma C-reactive protein was measured by the immunonephelometry (Dade Behring) method. Metabolic syndrome was defined according to the National Cholesterol Education Program Expert Panel. RESULTS: The mean C-reactive protein concentrations in the subjects grouped according to the presence of 0, 1, 2 and 3 or more features of the metabolic syndrome were 1.11, 1.89, 1.72 and 2.22 mg/L, respectively (p = 0.023) with a statistically, significant difference between those with 3, and without metabolic syndrome (p = 0.01). In the simple regression analyses C-reactive protein did not correlate with the total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, body mass index and blood pressure (p > 0.05). In the multiple regression analysis, waist circumference (beta = 0.411, p = 0.000), triglycerides to high density lipoprotein cholesterol ratio (beta = 0.774, p = 0.000), smoking habit (beta = 0.236, p = 0.003) and triglycerides (beta = 0.471, p = 0.027) were independent predictors of C-reactive protein. CONCLUSIONS: Our results suggested a cross-sectional independent correlation between the examined cardiovascular risk factors as the predominant features of metabolic syndrome and C-reactive protein in the group of apparently healthy subjects. The lack of correlation of C-reactive protein with the total cholesterol and low density lipoprotein cholesterol in our study may suggest their different role in the process of atherosclerosis and the possibility to determine C-reactive protein in order to identify high-risk subjects not identified with cholesterol screening.

Adult↗
PubMed2000

Using focus groups to develop a heart disease prevention program for ethnically diverse, low-income women.

Although low-income women have higher rates of cardiovascular disease (CVD) than higher-income women, health promotion and disease prevention are often low priorities due to financial, family, and health care constraints. In addition, most low-income women live in environments that tend to support and even promote high risk CVD behaviors. Low-income African-American, Hispanic, and White women constitute one of the largest groups at high risk for CVD but few heart disease prevention programs have effectively reached them. The purpose of this project was to use feedback from focus groups to generate ideas about how to best structure and implement future CVD intervention programs tailored to low-income populations. Seven focus groups were conducted with 51 low-income African-American, Hispanic, and White women from two urban and two agricultural communities in California. The women in the study shared many common experiences and barriers to healthy lifestyles, despite their ethnic diversity. Results of the focus groups showed that women preferred heart disease prevention programs that would address multiple CVD risk factors, emphasize staying healthy for themselves, teach specific skills about how to adopt heart-healthy behaviors, and offer them choices in effecting behavioral change. For health information, they preferred visual formats to written formats. They also expressed a desire to develop knowledge to help them separate health "myths" from health "facts" in order to reduce their misconceptions about CVD. Finally, they stressed that health care policies and programs need to address social and financial barriers that impede the adoption of heart-healthy behaviors.

Adult↗
PubMed2005

Healthy workplace environments support a nurturing student educational climate.

Due to the shortage of medical laboratory scientist personnel in the United States, the successful integration of students into the Medical Laboratory Science (MLS) profession is vital. Education Facilitators are being used increasingly to assist clinical site managers in actively supporting and contributing to a healthier workplace environment, thereby inspiring students to become part of the organization. Education Facilitators associated with a single university-based MLS Program were the participant target group in a study. Face-to-face, in-depth, semi-structured interviews were conducted with five Education Facilitators at two clinical sites. The findings of this study suggest that organizational efforts to improve the learning environment for MLS students should focus on providing a supportive and nurturing educational climate. Education Facilitators' descriptions revealed an organizational leadership that communicated a commitment to provide people, space, and equipment in an effort to promote a positive clinical rotation experience. Additionally, the facilitators expressed a need to "pay more attention to students," be "willing to work with students," and make sure the students don't get "lost in the shuffle." They said that concern for a healthy work/life balance should be communicated to MLS students through day-to-day educational contact with bench technologists and Education Facilitators.

Data Collection↗
PubMed1999

Mistreatment due to weight: prevalence and sources of perceived mistreatment in women and men.

OBJECTIVE: Previous research has documented prejudicial attitudes and discrimination against overweight people. Yet the extent to which overweight people themselves perceive that they have been mistreated because of their weight has not been carefully studied. The purpose of this study was to examine the prevalence of perceived mistreatment due to weight and sources of perceived mistreatment. METHODS AND PROCEDURES: A non-clinical sample of healthy adults (187 men and 800 women) enrolled in a weight gain prevention program comprised the study population. A self-administered questionnaire was used to measure perceived mistreatment due to weight. RESULTS: Overall, 22% of women and 17% of men reported weight-related mistreatment. The most commonly reported sources of mistreatment among women were strangers (12.5%) and a spouse or loved one (11.9%). Men were most likely to report mistreatment by a spouse or loved one (10.2%) and friends (7.5%). Somewhat surprisingly, sex differences in perceived weight-related mistreatment were significant only for stranger as the source. Perceived weight-related mistreatment was positively associated with body mass index (BMI) (r = 0.39, p<0.0001). Reported mistreatment was nearly ten times as pervalent among individuals in the highest quartile of the BMI distribution (42.5%) than among those in the lowest BMI quartile (5.7%), but was significantly greater than zero in all but the very lean. DISCUSSION: Perceived mistreatment due to weight is a common experience and is not restricted to the morbidly obese. Results are discussed in light of the sociocultural value for thinness.

Adult↗
PubMed2004

HIV and AIDS in adolescents.

HIV infection in adolescents continues to challenge health providers, policymakers, and advocates for youth. There will be no relief from its complexities soon. Primary care providers are in a unique position to use effective HIV prevention and care interventions. Successful programs move beyond moralism to realism. They show a willingness to engage young people and their families in a sensitive dialogue about the needs of youthful sexual development. Youth at high risk for HIV should be identified and referred to comprehensive care and counseling as soon as possible. HIV-positive youth need intensive individual and group interventions to remain healthy and reduce transmission to others. To protect their patient population, health care providers will need to commit time and effort to making adolescents services visible, flexible, affordable, confidential, culturally appropriate, and universally available.

AIDS Serodiagnosis↗
PubMed1995

Influence of posture on the visual field in glaucoma patients and controls.

The intra-ocular pressure rises when body position is changed from sitting to supine. This phenomenon occurs to the same extent in healthy people and glaucoma patients. The purpose of this preliminary study was to determine the effect of posture on the visual field. Visual fields of 15 eyes of 12 normal-tension glaucoma (NTG) patients, 16 eyes of 11 high-tension glaucoma (HTG) patients and 30 eyes of 26 healthy controls were measured in the upright and supine positions with program G1X on an Octopus swivel-arm perimeter. The delta mean defect (delta MD), that is MDupright-MDsupine, was calculated for each patient and compared among study groups. Whereas visual fields improved in healthy controls (delta MD = +0.45 dB), glaucoma patients showed a slight deterioration of the visual field after changing position from supine to upright (HTG: delta MD = -0.25 dB, NTG: delta MD = -0.24 dB). The difference between HTG and controls, as well as between NTG and controls, was statistically significant (p < 0.002, Student's t test). These findings indicate that in some glaucoma patients the regulatory mechanisms for blood supply in the optic nerve head are insufficient.

Adult↗
PubMedDate not supplied

5 A Day for better health--nine community research projects to increase fruit and vegetable consumption.

One of the national objectives in "Healthy People 2000" is for members of the public to increase their consumption of fruits and vegetables to five or more servings daily. The National Cancer Institute (NCI) began a nationwide campaign to achieve this objective in 1991. As part of this campaign, the NCI funded nine research studies in 1993. These projects are implementing and evaluating community-based programs designed to increase fruit and vegetable consumption among different segments of the population in Alabama, Arizona, Georgia, Louisiana, Maryland, Massachusetts, Minnesota, North Carolina, and Washington. The settings for these projects include the Special Supplement Food Program for Women, Infants, and Children (WIC Programs), churches, worksites, and schools. The projects are led by multidisciplinary teams and entail extensive collaboration among academic, governmental, private sector, and voluntary agencies within each State. The projects represent a model public health paradigm for conducting this type of research.

Diet↗
PubMed2005

Long-term all-sites cancer mortality time trends in Ohio, USA, 1970-2001: differences by race, gender and age.

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970-2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates--an overall difference was 7.5% in men in 1997-2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care.

Adult↗
PubMed2006

Ankle force and rate of force production increase following high intensity strength training in frail older adults.

BACKGROUND AND AIMS: The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling. Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults. Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly. This study evaluated the effect of a 10-week high intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults. METHODS: Thirteen experimental and fourteen control subjects, all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips. RESULTS: Following strength training the experimental group was significantly stronger than the control group. Mean ankle moments improved in the experimental group following strength training during forward sway (Right: p=0.067, Left: p=0.009) and backward sway (Right: p=0.031, Left: p=0.058). For the backward sway condition the ankle rate of torque production increased significantly in the experimental group (Right: p=0.016, Left: p=0.031). CONCLUSIONS: Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production, in response to balance threats.

Accidental Falls↗
PubMedDate not supplied

Health, education, work, and independence of young adults with disabilities.

PURPOSE: Healthy People 2010, the U.S. government's goal for a healthier nation, calls for improved data collection to understand the health status of relatively small population groups, such as young adults with disabilities. This study looks at the transition outcomes of graduates of pediatric systems of care for children with disabilities and chronic conditions. METHODS: Young adult graduates of a state program for children with special healthcare needs and a specialty children's hospital were sent a mail survey that focused on their healthcare access and use, insurance status, health behaviors and perceptions, education, work, and markers of independent living. The survey was based on the , National Longitudinal Survey of Youth, Behavioral Risk Factor Surveillance System, the U.S. Census and other surveys done by the state and hospital programs. Experts in healthcare and school-to-work transition of youth with special needs, health and labor economists, independent living center counselors, program administrators, nurses, social workers, and physicians offered ideas on various versions of the instrument that were piloted on youth before mailing to graduates. A follow-up mailing was sent to all those who did not respond to the first mailing. Results from the surveys of these young people with special healthcare needs are compared with data on typical young adults to determine the disparities. SAMPLE: Mail surveys were sent to all patients aged 18 years and older at the time of their discharge in the preceding fiscal (state program) or calendar (children's hospital) year. The response rate was 51%. Ninety-one percent of the respondents were Whites and 61% were women, with a median age of 21.1 years; 69% reported independence in activities of daily living. RESULTS AND DISCUSSION/CLINICAL RESULTS: Eighty percent of graduates reported having a usual source of care, but 42% used the emergency room compared with 25% of typical young adults. Twenty-nine percent had no health insurance and only 11% had insurance through their work. Only 44% of respondents were working compared with 56% of all 19 year olds and 72% of 18-29 year olds in studies of typical youth; 67% of those not working wanted to work. One great concern is the 26% who are not working, in school, or at home with children. Nurses working with children, families, and young adults can use the information to improve pediatric and adult healthcare systems and collaborate with educational, independent living, and workforce development agencies to improve transition to adult roles and responsibilities for young people with disabilities.

Activities of Daily Living↗
PubMed1999

Ischemic heart disease mortality and occupation among 16- to 60-year-old males.

Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.

Adolescent↗
PubMed2004

The comparative effectiveness among institutionalized and non-institutionalized elderly people in Taiwan of reminiscence therapy as a psychological measure.

This study examined the comparative effects of reminiscence on self-esteem, self-health perception, depressive symptoms, and mood status of elderly people residing in long-term care facilities and at home. A quasi-experimental design was conducted, using pre-intervention and post-intervention tests and purposive sampling. Rosenberg ' s Self-Esteem Scale (RSE), Health Perception Scale (HPS), Geriatric Depression Scale Short Form (GDS-SF), and Apparent Emotion Rating Scale (AER) were used as study instruments. Each subject was administered pre- and post-experimental tests at a four month interval and all subjects underwent weekly individual reminiscence intervention. Forty-eight subjects completed the study, with 25 institutionalized elderly people and 23 non-institutionalized home-based elderly people. Independent t-tests and paired t-tests were conducted to measure the differences in variable means between and within groups. A significant difference was found between groups in mood status post-test (t = 5.96, p <.001) and significant differences were noted in self-health perception, depressive symptoms, and mood status (t = -2.56, 2.83, -3.02; p =.018,.009,.007) between the pre- and post-intervention tests in the institutionalized group. These results suggest that reminiscence therapy is especially appropriate for older people who reside in care facilities. Implementing strategies that enrich the lives of elderly people residing in long-term cares is crucial, and reminiscence offers a method for promoting healthy aging.

Affect↗