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PubMed1990

Social networks and health: impact on returning home after entry into residential care homes.

This research extends the study of social network analysis and labeling theories into the context of residential care homes (RCHs). Findings suggest that: (1) when members of intense social networks decide to move elderly persons into RCHs, placement is truly needed and (2) although the likelihood of returning home from RCHs is affected by sociocultural characteristics, the functional and cognitive status of the resident are of primary importance.

Aged↗
PubMed1991

Educational differences in health status and health care.

Includes estimates by years of education for limitation of activity, restricted-activity days, assessed health status, physician contacts, hospital discharges and days, incidence of acute conditions, and prevalence of chronic conditions. Level of education is cross-classified by age, sex, race, poverty status, Hispanic origin, geographic region, place of residence, major activity, marital status, and employment status. All estimates are shown as unadjusted and age adjusted and are based on data collected in household interviews by the U.S. Bureau of the Census for the National Health Interview Survey during 1989.

Activities of Daily Living↗
PubMed1997

Training in firearm safety counseling in pediatric residency programs.

OBJECTIVE: To examine the status of formal training in pediatric residency programs with regard to firearm safety counseling. DESIGN: Survey. SETTING: Pediatric residency programs of the coterminous United States (N = 209). PATIENTS OR OTHER PARTICIPANTS: The population of pediatric residency program directors. INTERVENTIONS: None. MAIN OUTCOME MEASURES: A national baseline assessment of the proportion of pediatric residency programs with formal training on firearm safety counseling. In addition, the content taught, methods of provision, barriers to offering such training, and resources that could increase the number of programs offering such training. RESULTS: The response rate of the residency directors was 77%. One third of the residency programs offered formal firearm safety counseling training. Sixty-five percent of the respondents strongly agreed that it is the pediatrician's responsibility to counsel on this topic. Few residency directors (19%) perceived that firearm safety counseling would be effective in reducing the number of accidental firearm injuries or deaths. The 3 resources most frequently identified that, if available, would increase the amount of time residencies would spend on training were video training programs (64%), patient education materials (62%), and a curriculum guide (55%). CONCLUSIONS: Pediatricians have a vested interest in preventing childhood firearm violence. Yet, fewer than half of the residency directors believed that firearm issues be given high priority in residency programs. The barriers to providing such training (eg, no trained personnel and lack of educational resources) should not be major impediments to resolving this health problem.

Adult↗
PubMed1998

Differences in the effect of patients' socioeconomic status on the use of invasive cardiovascular procedures across health insurance categories.

OBJECTIVES: This study evaluated the effect of patients' socioeconomic status on use of coronary angiography, bypass grafting, and angioplasty across health insurance categories. METHODS: Multiple logistic regression was used to compute the odds of receiving each procedure among 206 233 ischemic heart disease patients residing in urban California zip codes from 1991 through 1993. RESULTS: Residents of high socioeconomic status areas were more likely (odds ratios [ORs] = 1.20-1.41) and residents of low socioeconomic status areas were less likely (ORs = 0.79-0.84) than residents of middle socioeconomic status areas to undergo each procedure. These effects were common among Medicare and health maintenance organization patients and uncommon for privately insured and uninsured patients. CONCLUSIONS: The effect of socioeconomic status varies across health insurance categories.

Adult↗
PubMed1986

Effects of gender, gonadectomy and social status on attack directed towards female intruders by resident mice.

Small unisexed groups (triads) of either male of female Swiss strain mice attack lactating intruders introduced into their home-cages. Female residents are, however, generally much more aggressive towards such intruders than are males. Ovariectomy of female residents (on day 15 or day 50 of life) has little effect on such responses, but castration of male residents significantly increases their attack on lactating intruders to a level resembling that of females. The introduction of the lactating female into the home-cage of sham-operated or gonadectomized male or female residents also enhances intragroup fighting with males (irrespective of their endocrine status) being the more aggressive. Finally, the social status of the male alters the response towards lactating females. Dominants generally show higher levels of attack, an effect that can be augmented by castration.

Aggression↗
PubMed2004

The sociodemographic correlates of schizophrenia in Butajira, rural Ethiopia.

OBJECTIVES: To describe the major sociodemographic correlates of schizophrenia, and their interactions, in a rural population of Ethiopia. METHODS: We have recently completed a study in Butajira to identify cases of major mental disorders for description of course and outcome. A total of 318 cases of schizophrenia were identified by a door-to-door survey of a predominantly rural population of close to 68,500 individuals. Cases were confirmed by use of the SCAN and clinical assessment. FINDINGS: The study showed that being male, under 35 years of age, unmarried, educated and living in an urban area were factors all associated with schizophrenia independently of each other. The risk of schizophrenia associated with being male was much higher in those aged 35 and over compared to those under 35 years of age. The risk of schizophrenia among males was higher in those not married (never married, separated, divorced or widowed) compared to those who were married. The association of marital status with schizophrenia was also more pronounced among those aged 35 year or over compared to those under 35. The association between schizophrenia and being unmarried was higher in urban than in rural areas. CONCLUSION: The sociodemographic correlates of schizophrenia in this rural population were similar to those described for the developed world. Furthermore, there were significant interactions between sex, age, marital status, area of residence and education as correlates of schizophrenia.

Adolescent↗
PubMed1993

[A longitudinal study on health status and factors relating to it in elderly residents of a community].

The purpose of the present study is to clarify the relationship of physical, sociological and psychological factors to health status, the decline in activities of daily living (ADL) and death, in community elderly residents, by analysis of participation or non-participation in a comprehensive health survey. Subjects were 737 elderly residents (306 males, 431 females) aged 70-75 years living at home in Fujishimamachi, a rural town of Yamagata prefecture. A baseline comprehensive health survey including door-to-door survey for non-respondents to the comprehensive survey, was performed in 1986, and repeated at follow-up five years later. The results obtained are as follows: 1) In both sexes, survival rate was highest in the respondents to the comprehensive health survey and lowest in non-respondents to either surveys. Causes of death, place of death, the bedridden period prior to death and ADL before bedridden status were different among those three groups. 2) Factors predisposing to ADL decline (all subjects had competent normal ADL at the baseline survey) were low self-rated health, low score of the Index of Competence developed by Tokyo Metropolitan Institute of Gerontology (the TMIG Index of Competence), inactivity in daily life especially in household affairs and social activities. The predicting factors of death were almost similar to those of ADL decline mentioned above. The relationship of the factors to health status was stronger in those who had to be surveyed door-to-door compared to respondents to the comprehensive health survey, and in women than in men. 3) Blood pressure, ECG findings, retinal findings, hand grip, memory as measured by the Benton Visual Retention Test showed no relationship to either ADL decline or mortality. 4) The present study shows that subjective health and functional capacity are useful to predict the outcome of community elderly residents. Further, life styles and health behavior have a significant effect on outcome prediction.

Activities of Daily Living↗
PubMedDate not supplied

Cross-domain variability of cognitive performance in very old nursing home residents and community dwellers: relationship to functional status.

BACKGROUND: Recent evidence suggests that cross-domain variability in cognition may be related to subsequent cognitive decline beyond mean performance levels in cognitive tasks. OBJECTIVES: To examine age-related changes in cross-domain variability across cognitive task performance in very old nursing home residents in contrast to community-dwelling older adults. To explore the relationship between cross-domain variability in cognition and functional disability in very old age. METHODS: 204 very old (82.00+/-8.51 years) residents from the Jewish Home and Hospital, Bronx, N.Y., and 376 community-dwelling older adults of similar age (86.75+/-5.84 years) were tested on a cognitive battery. Cross-domain variability scores were computed across the cognitive tasks. Functional disability measures were derived from the CDR (Clinical Dementia Rating) Scale. RESULTS: Whereas oldest old community-dwelling adults showed a decrease in variability across domains with age, variability increased with age in nursing home residents, irrespective of the level of cognitive performance. Cross-domain variability was associated with functional disability beyond the effects of age, gender, education, dementia status, residential status, and level of cognitive performance. CONCLUSION: Findings suggest that cross-domain variability in cognition is related to functional decline with age. Cross-domain variability in cognition may be a prominent predictor for the development of functional decline in very old adults.

Age Factors↗
PubMed1995

Validation of the Minimum Data Set Cognitive Performance Scale: agreement with the Mini-Mental State Examination.

BACKGROUND: Almost all nursing homes in the United States are required by the 1987 Omnibus Budget Reconciliation Act to assess each resident's functional, medical, psychosocial, and cognitive status using a standard instrument known as the Minimum Data Set (MDS). We report a validation study to show that the MDS Cognitive Performance Scale (CPS), a cognitive measure generated from 5 MDS items (comatose status, decision making, short-term memory, making self understood, and eating) can be used to detect cognitive impairment as defined by the Mini-Mental State Examination (MMSE). METHODS: Two hundred subjects were randomly recruited from 8 nursing home facilities in North Carolina. Two medical students administered the MMSE, while a geriatric research nurse was responsible for collecting MDS cognitive items, which included the 5 items required for generating CPS scores. Cognitive impairment was defined by MMSE scores adjusted for education. Agreement between the CPS and the MMSE in identifying cognitively impaired subjects was then evaluated. RESULTS: The CPS showed substantial agreement with the MMSE in the identification of cognitive impairment; the sensitivity was .94 (95% confidence interval [CI]: .90, .98), the specificity was .94 (95% CI: .87, .96), and the diagnostic accuracy as measured by the area under the receiver operating characteristics (ROC) curve was .96 (95% CI: .88, 1.0). CONCLUSIONS: The MDS Cognitive Performance Scale, when performed by a trained research nurse using recommended protocols, provides a valid measure of cognitive status in nursing home residents.

Aged↗
PubMed1977

The effect of the organization and status of family practice undergraduate programs on residency selection.

Family practice, as a medical specialty, is designed to help fill the void in primary care availability. In order to expose medical students to family practice and provide a basis for choosing a residency in the field, many medical schools have developed undergraduate programs in family practice. This paper reports the results of a survey conducted in March 1975 on the status of undergraduate programs with particular focus on the relationships between administrative status, size of program, faculty size, and type of undergraduate curricula to the number of graduates choosing family practice as a specialty. The data indicate that there is a relationship between the commitment of the school to family practice, the size of the program, and the presence of required courses in the curriculum to the success of the program, as measured by the proportion of students in each school who choose family practice residencies.

Education, Medical, Undergraduate↗
PubMedDate not supplied

Prevalence, awareness, treatment and control of hypertension in an elderly community-based sample in Kerala, India.

BACKGROUND: Hypertension is one of the most important causes of cardiovascular morbidity and mortality in the elderly. With the increase in the number of elderly in India, hypertension is likely to emerge as an important public health problem. METHODS: We performed a cross-sectional survey of a random sample of 357 community-dwelling elderly individuals (191 women, 166 men; mean age 70 years) in Kerala. We measured blood pressure on all study participants using a standardized technique to assess the prevalence of hypertension. We compared the variations in prevalence, awareness, treatment and control of hypertension according to age, sex and place of residence of the subjects, and examined the socio-demographic correlates of hypertension using sex-specific multiple logistic regression. RESULTS: The overall prevalence of hypertension in our sample was 51.8% (95% CI: 46.8%-56.8%), which did not vary with sex but increased with age. Fewer than half of the hypertensive subjects were aware of their condition or were on treatment, and only a quarter of the treated hypertensives achieved adequate control of blood pressure. Rural elderly subjects were especially less likely to be aware of, and on treatment for hypertension. Smoking status and rural residence (in men) and marital status (in women) were important correlates of hypertension. CONCLUSIONS: Our findings emphasize the public health importance of hypertension in the elderly in Kerala at present, and point to a likely increase in burden of this problem in India in the near future. A National Hypertension Programme, targeted to meet the imminent public health challenge posed by hypertension seems warranted.

Aged↗
PubMed1985

Cardiopulmonary resuscitation. Values and decisions--a comparison of health care professionals.

The authors studied the effect of various patient factors (biomedical, mental status, and psychosocial) on the decision to perform cardiopulmonary resuscitation by internal medicine house staff and registered nurses. Clinical vignettes were utilized to assess the likelihood of initiation of cardiopulmonary resuscitation (CPR) by the respondents. In most cases, these factors had similar significant effects on decisions to initiate CPR by both physicians and nurses. However, some differences in the likelihood of performing CPR were found between the physician and nurse populations, particularly in the areas of mental status and institutionalization. Dementia, mental retardation, and nursing home status all caused residents to be significantly less likely to initiate CPR than nurses (P less than 0.001). This study demonstrates that biomedical, mental status, and psychosocial patient factors have a significant impact on the decision to initiate CPR by both internal medicine residents and nurses. These decisions apparently are rooted in similar criteria, although the basis for the differences between the two groups warrants further study.

Adult↗
PubMedDate not supplied

Effects of residence in Alzheimer disease special care units on functional outcomes.

CONTEXT: Alzheimer disease special care units (SCUs) in nursing homes are increasingly prevalent, but little is known about their effects on residents' outcomes. OBJECTIVE: To analyze the effect of SCU residence on the rates at which residents decline in functional status. DESIGN: A cohort of nursing home residents assessed at multiple points during about 1 year. Facility staff completed all assessments using the Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS). SETTING: Medicare- or Medicaid-certified nursing facilities. PATIENTS OR OTHER PARTICIPANTS: All nursing home residents in 1993 and early 1994 in Kansas, Maine, Mississippi, and South Dakota. Serial MDS assessments of 77337 residents in more than 800 facilities, including 1228 residents in 48 facilities with SCUs. MAIN OUTCOME MEASURES: Decline in locomotion, transferring, toileting, eating, dressing, and a summary activities of daily living index; decline in urinary and bowel continence; and significant weight loss. RESULTS: No statistically significant difference was observed in the speed of decline for residents in SCUs and traditional units in any of the 9 outcomes. Residents were matched on a variety of characteristics, and subgroup analyses were performed. In none did we observe a pattern of better outcomes among SCU residents. CONCLUSIONS: Although SCUs may have provided unmeasured benefits to families and residents, it does not appear that those benefits included any slowing in the rates of functional decline experienced by individuals with dementia.

Activities of Daily Living↗
PubMed2004

How safe is primary knee replacement surgery? Perioperative complication rates in Northern Illinois, 1993-1999.

OBJECTIVE: To describe inpatient complications for primary total knee replacement (TKR) in a period of rapidly growing orthopedic surgery capacity, declining length of stay, and more frequent discharge to rehabilitation facilities. METHODS: Complication incidence according to published coding algorithms was estimated for 35,531 primary TKR admissions of northern Illinois residents to 65 Illinois hospitals. Complication odds were estimated as a function of patients' clinical and sociodemographic status, hospital volume, residency training, TKR length of stay, International Classification of Diseases, Ninth Revision (ICD-9) coding intensity, and discharges to skilled nursing or rehabilitation facilities. RESULTS: Primary TKR admissions increased 36% between 1993 and 1999, length of stay declined 43%, average ICD-9 code use increased 31%, and rehabilitation discharges increased 68%. Major complication rates declined 44% (12.4% to 6.9%; P < 0.0001) over this period, reflecting a 50% reduction in the adjusted odds of complication between 1993 and 1999. There was no association of procedure volume and outcome. CONCLUSION: It is likely that the reduction in complications reflects true safety improvements as well as reduced length of stay.

Adolescent↗
PubMed2001

Socio-demographic variations in smoking status among Australians aged > or = 18: multivariate results from the 1995 National Health Survey.

OBJECTIVE: To determine the association between socio-demographic variables and smoking status in a national sample of Australians aged > or = 18. METHOD: The data came from the 1995 National Health Survey (NHS), which was conducted by the Australian Bureau of Statistics (ABS). Information was collected from 20,165 females and 18,948 males using face-to-face interviews. The dependent variable was smoking status distinguishing regular smokers from occasional, ex-smokers and never-smokers. Multiple logistic regression was used to examine the association of smoking status with gender, age, marital status, region of residence, country of birth and three socio-economic measures. RESULTS: Analyses showed that gender, age, marital status, country of birth and socio-economic position were significantly related to smoking status. The odds of being a smoker were largest for respondents who were 20-34 years old, were not married, had a low socio-economic standing, and were born in the Middle East, southern and western Europe for men, and the United Kingdom/Ireland and western Europe for women. The results also revealed that the geographic measure of socio-economic status had a stronger association with smoking likelihood than the individual level indicators (education and income), suggesting the importance of the social environment. CONCLUSION: There is substantial socio-demographic variability in smoking status. IMPLICATION: Of groups identified as having higher smoking rates, the socio-economically disadvantaged groups have the highest priority for targeted campaigns.

Adolescent↗
PubMed1996

[Analysis of mortality by civil status. Tumors of the digestive system].

Mortality data for the years 1981-1984 have been analyzed by marital status, sex and residence area. Results show high levels of mortality in widowers and widows, especially in areas with high mortality risks. In stomach cancer the widowers/widows mortality excess, compared to married and unmarried, is constant all over the country and does not change in the areas with high levels of mortality. Also for liver cancer mortality the widows show, everywhere, a constant excess compared to unmarried women. Widowers and unmarried men, if resident in north-west, show similar rates; while mortality levels for unmarried men approach those of married ones as the latitude of residence areas decreases and in the south they are equal. Mortality by ages confirms differences by marital status and shows, for many sites, larger variation in the age classes younger than 65-69 years.

Adolescent↗
PubMed2001

Accuracy and bias of licensed practical nurse and nursing assistant ratings of nursing home residents' pain.

BACKGROUND: This study evaluated the accuracy of licensed practical nurses' (LPN) and nursing assistants' (NA) Minimum Data Set (MDS) pain ratings of nursing home residents and evaluated the bias in pain ratings associated with residents' race, gender, mental status, function, depression, or disruptive behavior. METHODS: Data were obtained on the same day directly from residents, LPNs, and NAs by trained interviewers in two safety-net nursing homes. A total of 252 residents were included in this study: 79% were Black, and 60% were men. MDS items J2a and J2b evaluated pain frequency and pain intensity during the last 7 days (weekly pain frequency and weekly pain intensity). A parallel question evaluated pain intensity on the day of the interview (daily pain intensity). MDS data were obtained for the MDS Cognition Scale, the MDS Activities of Daily Living-Long Form Scale, the MDS Depression Rating Scale, and the MDS Disruptive Behavior Scale. RESULTS: Kappa coefficients documented fair to good resident-LPN (K =.70,.56, and.50) and resident-NA (K =.72,.58, and.60) agreement for weekly pain frequency, weekly pain intensity, and daily pain intensity ratings. LPNs and NAs underestimated residents' weekly pain frequency (p <.001 for LPNs, and p <.001 for NAs), weekly pain intensity (p <.001 for LPNs, and p <.001 for NAs), and daily pain intensity (p <.001 for LPNs, and p =.002 for NAs). LPNs underestimated weekly and daily pain intensity more than NAs did (p =.016 for weekly pain intensity, and p =.035 for daily pain intensity). LPN and NA pain ratings were not biased by resident race, gender, mental status, function, depression, or disruptive behavior. CONCLUSIONS: Results documented that (i) LPNs and NAs underestimated residents' pain frequency and pain intensity, (ii) NAs were more accurate than LPNs for pain intensity, and (iii) resident characteristics did not bias LPN or NA pain ratings.

Activities of Daily Living↗
PubMed1991

Health status of hostel dwellers. Part II. Infant mortality and prevalence of diabetes, hypertension and syphilis among adults.

The range of biomedical criteria selected to measure the health status of the residents of the urban migrant council-built hostels of Langa, Nyanga and Guguletu were investigated in a single survey. A single survey method screens health status and provides the opportunity to examine the interrelationship between findings on the different health criteria. Here a high infant mortality rate is examined against a low prevalence of diabetes, hypertension and syphilis and some of the effects of migrant labour on the health status of migrant hostel dwellers are identified. The low prevalence of disease among the Cape Town hostel residents suggests that migrant labour, by sifting out the able-bodied and employable, reproduces a 'healthy worker effect' among the migrant population with access to the city. The high infant mortality rate, in contrast, suggests that the disease burden of the migrants is being carried by the home-base population.

Adult↗