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PubMed2002

Health characteristics and health services utilization in older adults with intellectual disability living in community residences.

BACKGROUND: The health status and health needs of adults with intellectual disability (ID) change with advancing age, and are often accompanied by difficulties with vision, hearing, mobility, stamina and some mental processes. AIM: The present study collected health status information on a large cohort of adults with ID aged > or = 40 years living in small group, community-based residences in two representative areas of New York State, USA. METHOD: Adult group home residents with ID aged between 40 and 79 years (n = 1371) were surveyed to determine their health status and patterns of morbidity. RESULTS: Most subjects were characterized as being in good health. The frequency of cardiovascular, musculoskeletal and respiratory conditions, and sensory impairments increased with age, while neurological, endocrine and dermatological diseases did not. Psychiatric and behavioural disorders declined with increasing age, at least through 70 years of age. Although most conditions increased with age, their frequency varied by sex and level of ID. Frequencies of age-related organ system morbidity were compared to data from the National Health and Nutrition Evaluation Survey III. It was found that adults with ID had a lower overall reported frequency of cardiovascular risk factors, including hypertension and hyperlipidaemia, and adult-onset diabetes. Inconsistencies with mortality data among older adults with ID were observed (which showed equal if not greater prevalence of deaths as a result of cardiovascular disease and cancer). CONCLUSION: These results suggest that either a cohort effect is operating (i.e. contemporary populations are healthier than previous populations), or that there may be under-recognition of select risk factors and diseases.

Adult↗
PubMed2002

Elderly Canadians residing in long-term care hospitals: Part II. Dental caries status.

BACKGROUND: Dental caries has been identified as a significant problem for elderly residents of long-term care (LTC) hospitals in developed countries, yet little recent information is available for the Canadian population. OBJECTIVE: To document the caries status of elderly dentate residents of intermediate and extended LTC hospitals in Vancouver and surrounding communities. METHODS: A dentist examined the teeth of 369 elderly dentate hospital residents (coronal and root surfaces) for caries. The medical, dietary, oral microbial, oral hygiene and dental status of the same subjects are documented and discussed in a companion article. RESULTS: Two hundred and ninety (78.6%) of the subjects had at least one carious lesion; 186 (50.4%) had coronal caries and 254 (68.8%) had root caries. On average, each subject had 3.8 carious teeth. The residents of extended LTC hospitals had significantly more carious coronal surfaces. Lactobacillus scores were correlated with the DMFS (decayed, missing, filled surfaces), the number of carious coronal lesions, the number of carious surfaces and the plaque index, but Streptococcus mutans scores were correlated only with DMFT (decayed, missing, filled teeth). CONCLUSIONS: Overall, the prevalence of dental caries among the elderly residents of LTC hospitals in this study was high, although almost half of the subjects had visited community dentists within the previous 5 years. Caries prevention strategies (specifically diet, oral hygiene and antimicrobial agents) rather than treatment alone may be needed to control caries in this susceptible population.

Aged↗
PubMed2006

Racial differences in the relationship between infant mortality and socioeconomic status.

This study presents an ecological analysis of the relationship between infant mortality and economic status by race in metropolitan Ohio, using census data on mother's residence and economic status determined by the percentage of low-income families living in each area. The analysis updates previous studies as white-non-white comparisons for total infant mortality are examined for the US censuses of 1960, 1970, 1980, 1990 and 2000; and more detailed period- and broad cause-specific rates are presented for 2000. A pronounced inverse association is consistently found between income status and infant mortality for whites, while for non-whites this pattern first emerges in 1979-81, disappears during the 1980s and then returns more strongly during the 1990s. Similarly, the 2000 data reveal a consistent inverse pattern between income status and infant mortality for white and non-white neonatal and postneonatal death rates, as well as exogenous cause-specific death rates. It is concluded that low-income whites and non-whites have infant mortality rates substantially higher than the overall rate for the population. Policy implications are discussed.

Censuses↗
PubMed2004

Skipping of meals has a significant impact on dietary intake and nutritional status of old (65+ y) nursing home residents.

BACKGROUND: In spite of a high prevalence of undernutrition among old nursing home residents, studies have generally reported a mean intake of energy sufficient to cover the mean estimated energy requirement. This discrepancy could be due to skipping of meals and hence periods of insufficient energy intake too intermittent to be identified, when mean results are presented. OBJECTIVE: To examine the significance of skipping of (part of) meals on dietary intake and nutritional status of old (65+y) nursing home residents. DESIGN: Participants were 132 nursing home residents (84 (82-85) y). They were characterised according to activity of daily living-functions (ADL-functions), cognitive performance, intake of energy and protein (4-days dietary record), skipping of meals, energy and protein balance, and nutritional status (body mass index (BMI)). RESULTS: The participants had an energy intake, which was significantly higher than the estimated energy requirement (p <0.001). However, 41 (31%) had nothing to eat or only had desert at one or more meals during the 4-day registration period. Participants who were skipping meals had a lower BMI, energy and protein intake (all p <0.001) and a higher prevalence of negative protein balance (p <0.01), than the other residents. CONCLUSION: More focus should be given to individualized nutritional assessment in order to discover the cause to this problem and target individuals who could be helped by nutritional intervention.

Activities of Daily Living↗
PubMed2003

Health effects on nearby residents of a wood treatment plant.

OBJECTIVES: The aim of the study was to evaluate the health status of nearby residents of a wood treatment plant who had sustained prolonged low-level environmental exposure to wood processing waste chemicals. METHODS: A population of 1269 exposed residents who were plaintiffs or potential plaintiffs in a lawsuit against the wood treatment plant were evaluated by questionnaire for a health history and symptoms. A representative sample of 214 exposed subjects was included in the analysis. One hundred thirty-nine controls were selected from 479 unexposed volunteers and matched to the exposed subjects as closely as possible by gender and age. Subjects and controls completed additional questionnaires and were evaluated by a physician for medical history and physical examination, blood and urine testing, neurophysiological and neuropsychological studies, and respiratory testing. Environmental sampling for wood processing waste chemicals was carried out on soil and drainage ditch sediment in the exposed neighborhood. RESULTS: The exposed subjects had significantly more cancer, respiratory, skin, and neurological health problems than the controls. The subjective responses on questionnaires and by physician histories revealed that the residents had a significantly greater prevalence of mucous membrane irritation, and skin and neurological symptoms, as well as cancer. (Exposed versus unexposed, cancer 10.0% versus 2.08%, bronchitis 17.8% versus 5.8%, and asthma by history 40.5% versus 11.0%) There were significantly more neurophysiologic abnormalities in adults of reaction time, trails A and B, and visual field defects. CONCLUSIONS: Adverse health effects were significantly more prevalent in long-term residents near a wood treatment plant than in controls. The results of this study suggest that plant emissions from wood treatment facilities should be reduced.

Adolescent↗
PubMed1996

Racial differences in the relationship between infant mortality and socioeconomic status.

This paper presents an ecological analysis of the relationship between infant mortality and economic status by race in metropolitan Ohio, using census data on mother's residence, and economic status determined by the percentage of low income families living in each area. White-non-white comparisons for total infant mortality are examined for the US censuses of 1960, 1970, 1980 and 1990; and more detailed period- and broad cause-specific rates are presented for 1990. A pronounced inverse association is found between income status and infant mortality for whites, but not for non-whites. Non-white post-neonatal death rates were higher for the lowest income area, but for neonatal mortality, total infant deaths, and exogenous and endogenous cause-specific death rates, there was no discernible socioeconomic differential. It is concluded that low income whites and non-whites at all income levels have infant mortality rates that are substantially higher than the overall rate for the population. Policy implications are discussed.

Cause of Death↗
PubMed1994

Functional status of Mexican American nursing home residents.

OBJECTIVE: To compare sociodemographic characteristics, physical function, and cognition of Mexican American and non-Hispanic white nursing home residents. DESIGN AND SETTING: Cross-sectional survey of residents in eight proprietary nursing homes and one Veterans Affairs nursing home in San Antonio, Texas. SUBJECTS: Residents with lengths of stay greater than or equal to 90 days. MEASUREMENTS: Sociodemographic characteristics, residence prior to admission, and dependency in activities of daily living (ADL) were abstracted from the medical record. The Folstein Mini-Mental State Examination (MMSE) was administered in the resident's self-selected language to a subset of residents. MAIN RESULTS: There were 1160 participants, 261 Mexican American (23%) and 899 non-Hispanic white residents (77%). Mexican Americans were younger (77.1 vs 80.7 years), more often men (44% vs 30%), less educated (6.2 vs 10.8 years), and more often dependent on Medicaid funding (66% vs 40%) than non-Hispanic whites. Mexican Americans were less independent in feeding (34% vs 49%), transfers (18% vs 30%), toileting (19% vs 29%), and dressing (12% vs 19%). Mean MMSE scores were different in Mexican Americans and non-Hispanic whites (8.93 vs 11.85), and this difference remained significant after adjustment for age and education (P = 0.04). ADL function was strongly associated with MMSE (P = 0.0001) and less strongly associated with ethnicity (P = 0.056) in multiple regression analysis. CONCLUSIONS: This study provides the strongest evidence to date that Mexican American nursing home residents are more cognitively and functionally impaired than non-Hispanic white residents. Further studies should explore whether medical conditions, selection and referral patterns or cultural factors explain functional differences between Mexican American and non-Hispanic white nursing home residents.

Activities of Daily Living↗
PubMed1983

Social aspects of chronic duodenal ulcer. A case control study.

A case-control study of 80 patients with duodenal ulcer and 80 community controls was undertaken to compare these two groups regarding social and environmental factors including socio-economic status, marital status, country of birth, childhood and family factors. An increased risk of duodenal ulcer was associated with status incongruity in males; the male patients, when matched on suburb of residence, having lower status occupations than controls, and when matched on occupational status, tending to have lower educational levels than controls. Being unmarried was associated with an increased risk of duodenal ulcer in females. The number of siblings was also a risk factor in the male patients, those with more than 5 siblings being at an increased risk. Factors not associated with duodenal ulcer included country of birth, childhood happiness, sibling sequence and family stability. In conclusion, the factors associated with chronic duodenal ulcer were found predominantly in adult life and could produce their adverse effects by causing chronic stress which may be more relevant than acute stress as produced by major life events.

Chronic Disease↗
PubMed2005

Caries experience and status in school-age children residing in four North Italian communities.

PURPOSE: The aim of this paper was to describe the caries experience in four North Italian areas. The areas selected were four North Italian medium-sized cities: San Remo located in western Liguria, Ferrara in Emilia, and Varese and Melegnano (Milan suburbs). MATERIALS AND METHODS: 1104 subjects (560 males and 544 females) were examined. Several dental outcomes were used: DMFT Index and SiC index following WHO recommendations; and the caries experience ratio; the percentage of children with high caries disease and with rampant caries was calculated as the percentage of subjects with DMFT > 0, DMFT > or = 4 and DMFT > or = 7. RESULTS: Mean DMFT ranged from 1.21 +/- 1.65 in the Ferrara group to 1.83 +/- 2.49 in San Remo. Among the groups, statistically significant differences were observed for DT and DMFT (p = 0.04 and p = 0.01 respectively). The SiC index was 3.75 +/- 1.87, 3 (2-5) in all samples, with significant differences among the four areas (p = 0.04). No statistical differences were observed among the four areas regarding caries experience and the proportion of children with high and rampant caries. An elevated proportion of subjects with high caries (DMFT > or = 4) was noted in the San Remo group (22.9%). The distribution of children by gender according to DMFT levels was not statistically significant either. The F/DMFT ratio was similar in the survey areas, from 0.30 in San Remo, 0.38 in Varese and Ferrara, to 0.40 in the Milan suburbs. CONCLUSION: Information drawn from this study can be helpful to describe and plan future dental prevention programmes aimed at reducing caries experience and promoting better oral health level.

Analysis of Variance↗
PubMed1987

Magnesium, calcium, sodium and potassium status in normotensive and hypertensive Johannesburg residents.

Serum magnesium, calcium, sodium and potassium, and erythrocyte magnesium, sodium and potassium levels were measured in a selected group of 296 urbanised black male labourers in Johannesburg. Of these, 214 subjects were normotensive and 82 were hypertensive. The aim of the study was to examine the relationship between serum and erythrocyte electrolytes, specifically magnesium and calcium, and blood pressure in this population sample. The results showed a significant decrease in serum magnesium, calcium and potassium in the hypertensive subjects. Red blood cell magnesium was significantly lowered and red blood cell sodium was significantly raised in this group. A significant inverse correlation was found between serum magnesium and blood pressure, erythrocyte magnesium and blood pressure, serum calcium and blood pressure, and serum potassium and blood pressure. A positive correlation was observed between erythrocyte sodium and blood pressure. Of all the electrolytes assessed, magnesium (serum and erythrocyte) correlated most closely with blood pressure. The data reported here suggest that body magnesium and its interactions with calcium, sodium and potassium may, in certain groups of individuals, play an important role in the development and maintenance of high blood pressure.

Black People↗
PubMed1978

Immunization status of patients in a residency-based family practice.

Immunization studies in the United States have revealed that about 35 percent of children are not adequately immunized. This family practice residency desired to evaluate its immunization patterns, particularly since it was involved in the education of physicians. All of the charts of those patients from birth to 14 years of age were reviewed from July 1, 1974, when the residency accepted its first residents until April 1, 1977, when this evaluation was completed. The results revealed two patterns. First, the older the patient the less likely that his/her immunizations were up to date. Secondly, the older the patient the more likely that there were no immunization records. The evaluation resulted in the initiation of many improvements in patient and staff education which, it is hoped, will enable the desired goal of having the immunization up-to-date percentages raised to 95 percent within two years.

Adolescent↗
PubMed1998

Perceptions of well-being among the older metropolitan and nonmetropolitan populations in the United States.

The relationships were examined between selected sociodemographic variables and perceptions of well-being among residents 60 years and older of metropolitan and nonmetropolitan areas in the United States. Multiple regression models were used in analyzing data from the 1982-1991 NORC General Social Survey. Such sociodemographic variables as gender, race, marital status, education, financial status, place of residence, religious membership, and religious attendance were independent variables. A composite score of perceptions of well-being was the dependent variable. Race, marital status, education, financial status, religious attendance, and place of residence were important to well-being; gender and religious membership were not significant. The effects of nonmetropolitan living also significantly enhanced perceptions of well-being. Other facets of mental health in metropolitan and nonmetropolitan areas were also examined.

Aged↗
PubMed1995

Are postoperative complications related to resident sleep deprivation?

This real-world study compares the outcome of surgery and the sleep-deprivation status of the resident surgeon. Residents who operated the day after a 24-hour on-call period were considered sleep deprived; all other resident surgeons were considered non-sleep-deprived. We retrospectively reviewed data on 6,371 surgical cases and identified 351 postoperative complications. The complication data were analyzed using logistic regression analysis, with outcome being the presence or absence of surgical complications. No statistically significant change in complication incidence was noted when the resident surgeon was sleep deprived.

Clinical Competence↗
PubMed2006

Use of prenatal care by Hispanic women after welfare reform.

OBJECTIVE: The 1996 Personal Responsibility Work Opportunity Reconciliation Act (PRWORA, "welfare reform") changed immigrants' eligibility for publicly funded services such as Medicaid. However, implementation of the PRWORA varied by state. Florida implemented the eligibility restrictions, while California and New York preserved eligibility. Our objective was to compare the effect of state of residence and immigration status on use of prenatal care among Hispanic women in the period following the enactment of PRWORA. METHODS: In 1999-2001, we interviewed 3,242 postpartum Hispanic women in California, Florida, and New York. The dependent variable was use of prenatal care, dichotomized as adequate (initiated during the first trimester and > or = 6 visits, referent) or inadequate (initiated during the first trimester and < 6 prenatal visits or initiated after the first trimester). The primary independent variables were state of residence and maternal immigration status (U.S.-born citizens in New York, reference group). RESULTS: Thirteen percent of women were U.S.-born citizens, 8% were foreign-born citizens, 15% were documented immigrants, and 64% were undocumented immigrants. In Florida, women in all immigration subgroups were 2-4 times more likely to make inadequate use of prenatal care than U.S.-born citizens in New York. Documented immigrant women in New York were 90% more likely to make inadequate use of prenatal care than U.S.-born citizens in New York. CONCLUSION: Among Hispanic women in California, Florida, and New York, the state of residence, a measure of PRWORA policy changes, was associated with use of prenatal care. LEVEL OF EVIDENCE: II-2.

Adolescent↗