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PubMedDate not supplied

Lessons learned from providing transition services to adolescents with special health care needs.

This article provides insight and information about obstacles adolescents with special health care needs (ASHCNs) face as they progress to adulthood. Descriptions of these challenges are based upon clinical experiences in providing transition services to youth by the service coordinator seen through the Creating Healthy Futures transition clinic. These obstacles were classified as those related to health care, employment, education, independent living, social and recreational skills, and the service system. Information is also provided on the strategies project staff developed to assist youth in dealing with the challenges of the transition obstacles they faced.

Adolescent↗
PubMedDate not supplied

[Changes in factors associated with the nutrition transition in Mexico].

OBJECTIVES: To describe the demographic and socioeconomic changes, food availability and food expense in Mexico during 1980-2000. METHODS: From official statistics (Population Census, FAO Food Balance Sheets, Family Income and Expense National Survey and Economic Census) we estimated the evolution of population distribution according to locality size, occupational structure, woman participation in the wage-earning labor force, minimum wage, availability of food establishments and expense in food. RESULTS: The percentage of the population that lives in urban areas has increased, they are employed in the tertiary sector, womens participation in the labor market has increased but real minimum wages have decreased. Vegetables, oleaginous, oils, fish and seafood availability have decreased whereas animal fat, vegetables, fruits, softdrinks, meats and egg availability have increased. The number of inexpensive restaurants (cocinas económicas and fondas) has also increased. Food expenses have decreased while amount of money spent in food consumed away from home has increased. CONCLUSIONS: In Mexico, the growth in urban areas and the tertiary job sector shows a parallel growth in the availability of high fat and protein food, a greater diet variety and more opportunities to consume food not prepared in the home. On the other hand, the sale of equipment and places designed for recreational physical activity have increased. By reducing employment in the primary sector it is foreseeable that labor intensive physical activity will become less important overtime.

Female↗
PubMed2006

[Nutrition transition: a review of Latin American profile].

The nutrition situation has evolved in different ways in Latin-American countries. The aim of the study was to analyze the nutritional change and some conditions within Latin America in the last years. An electronic and manual search of articles published between 1995 and 2005 was made, selecting those that included the nutritional situation of Latin American countries. Additionally, data was collected from national surveys and international reports including information since 1990. The countries have evolved through different transition stages. For example, an increase of excess of weight, particularly in adult women, which exceeded 30% in some countries also reached up to 70% in others. Equally worrisome was the over 6% obesity level in children in five of the countries surveyed. There is a tendency to diminish the deficit of weight with seven of nine countries displaying a reduction of women with low weight while stunting diminished globally. An increase of the caloric availability in 17 of 20 countries was also observed. The total population that lives under the poverty line has diminished in 9 of 13 countries although some exceeded 60%. Some indicators of sedentary lifestyle have increased, the number of cars has been increasing in all countries and similar figures are recorded with respect to television and personnel computers. The evolution of the nutritional status is reflected through the action of set factors, the most important of which being the increase in caloric ingestion and sedentary activities in an urbanized environment, the promotion of the use of technologies that limit physical activity. There is also a reduction in food insecurity due to a fall in poverty levels although social inequalities still persist.

Adult↗
PubMed1998

Neonatal mortality in the Czech Republic during the transition.

OBJECTIVES: To identify factors underlying the reduction in neonatal mortality in the Czech Republic during the 1990s and to identify scope for further improvements. DESIGN: Examination of trends in birth weight and birth weight specific neonatal mortality in the Czech Republic and comparison with figures from Sweden, which has one of the lowest neonatal mortality rates in Europe. SETTING: The Czech Republic. SUBJECTS: All singleton births occurring in the Czech Republic in 1989-1991 and 1994-1995, with a comparison group of all singleton births in Sweden in 1989-1991. MAIN OUTCOME MEASURES: Neonatal mortality rate. RESULTS: Despite a slight worsening in the birth weight distribution, the neonatal mortality rate in the Czech Republic fell from 5.6 to 3.8 per thousand live births. This was due to an improvement in the survival of infants at all birth weights but especially amongst the lightest. Eighty percent of the overall improvement was due to greater survival among those under 2500 g. Comparison with Swedish birth weight specific rates indicates that, for the country as a whole, only small additional gains are likely as a result of improved survival at a given birth weight but, instead, a reduction in the proportion of low birth weight babies would have a much greater effect. Regional analysis indicates that the improvements have been much greater in Prague than in the rest of the country. CONCLUSIONS: An effective strategy to reduce neonatal mortality in the Czech Republic should have two elements. The first is to address the socio-economic determinants of low birth weight. The second is to reduce regional inequalities in the quality of neonatal care. This should, however, be supplemented by more detailed investigation to identify specific amenable factors.

Birth Weight↗
PubMed2002

Epidemiological and nutritional transition in Mexico: rapid increase of non-communicable chronic diseases and obesity.

OBJECTIVE: The objective of this paper is to characterise the epidemiological and nutritional transition and their determinants in Mexico. DESIGN: Age-adjusted standardised mortality rates (SMRs) due to acute myocardial infarction (AMI), diabetes mellitus and hypertension were calculated for 1980-1998. Changes in the prevalences of overweight and obesity in women and children and of dietary intake from 1988 to 1999 were also used in the analysis. Quantities of food groups purchased by adult equivalent (AE) and food expenditures away from home between 1984 and 1989 were used to assess trends. All information was analysed at the national and regional levels, and by urban and rural areas. RESULTS: SMR for diabetes, AMI and hypertension increased dramatically parallel to obesity at the national and regional levels. Fat intake in women and the purchase of refined carbohydrates, including soda, also increased. DISCUSSION: The results suggest that obesity is playing a role in the increased SMRs of diabetes, AMI and hypertension in Mexico. Total energy dietary intake and food purchase data could not explain the rise in the prevalence of obesity. The increases in fat intake and the purchase of refined carbohydrates may be risk factors for increased mortality. Information on physical activity was not available. CONCLUSION: SMRs due to diabetes, hypertension and AMI have increased dramatically in parallel with the prevalence of obesity; therefore actions should be taken for the prevention of obesity. Reliable information about food consumption and physical activity is required to assess their specific roles in the aetiology of obesity.

Acute Disease↗
PubMed2006

A simple method to estimate tobacco-related lung cancer deaths based on smoking prevalence data.

OBJECTIVE: Tobacco is the major cause of cancer and a relevant risk factor for several other chronic diseases. Due to the epidemiological transition in developing countries with overall increasing life expectancy there is an increasing relevance of chronic diseases to the total burden of diseases. Furthermore, there are indications for a rise in the consumption of tobacco products in developing countries. Since in Africa data on smoking prevalence are scarce and cancer diagnosis is often imprecise or missing, it is difficult to estimate the current and future number of cancer cases attributable to tobacco smoking. In this paper, we present an approach to estimate the effects of smoking on lung cancer in selected developing countries in Africa. METHODS: We combined data on smoking prevalence from different African countries with estimates on age-specific lung cancer rates in smokers and non-smokers from industrialized countries and data on age and sex distribution in African countries. We perform a sensitivity analysis to evaluate the effect of the assumptions necessary for the procedure. RESULTS: If the smoking prevalence in African countries will remain on the current level, we estimate age-specific lung cancer rates lower than those in Germany. Despite the relatively small proportion of adults aged 50 and more which is the age when most cancer cases occur, there is an appreciable number of deaths from lung cancer that could be prevented when smoking prevalence could be reduced. Depending on assumptions we estimate up about 50,000 lung cancer deaths per year in Africa, most of which could be prevented. CONCLUSIONS: Efforts for smoking prevalence reduction are much more needed in the developing world. Better and more comprehensive data on smoking are needed for more precise estimates.

Adolescent↗
PubMed2001

Economic impact of an infection control education program in a specialized preschool setting.

OBJECTIVE: To assess the economic impact, from a societal perspective, of a multidimensional infection control education program (ICEP) in a preschool for children with Down syndrome. METHODS: Krilov et al implemented a comprehensive ICEP in a specialized preschool setting and reported a significant decrease in medical resource utilization and days absent from school. Clinical and economic data from Krilov et al and other sources were incorporated into a health-state transition (Markov) decision analysis model that estimated annual expected costs for the baseline and intervention years. Procedure and diagnosis codes were assigned to all physician office visits, emergency department visits, hospitalizations, and laboratory and diagnostic tests. Cost estimates then were derived using 1999 national reimbursement schedules and other sources. Productivity losses for parents were estimated using national wage rates. The costs of the ICEP were compared with the reduction in the costs of illness (direct medical costs plus costs associated with lost parental working time). The outcomes measured were mean annual costs of illness per child, total annual ICEP costs, and net annual costs or savings. RESULTS: With a comprehensive ICEP, the mean costs of illness in the baseline year was $1235 per child, of which 68% and 14% were for productivity losses and physician visits, respectively. In the intervention year, the mean costs of illness per child was $615, of which 71% and 20% were for productivity losses and physician visits, respectively. The cost of the preexisting infection control (IC) practices in place at the onset of the study (baseline year) was $716. The comprehensive ICEP cost (intervention year) was $75 627, 92% of which was spent to hire a cleaning service to decontaminate toys 3 times per week. When a secondary analysis was performed to reflect a less intensive ICEP in a nonspecialized preschool setting, the mean costs of illness in the baseline and intervention years were $962 and $614 per child, respectively, representing a total annual cost-of-illness savings of $13 224 for the 38 children who participated in the study by Krilov et al. The annual incremental cost of the less intensive ICEP was $2371; therefore, the estimated net annual savings of the less intensive ICEP in a nonspecialized preschool was $10 853. CONCLUSIONS: This study suggests that the reduction in the costs of illness could more than offset the cost of implementing a multidimensional ICEP in a preschool setting.

Child Day Care Centers↗
PubMedDate not supplied

Potentially unintended discontinuation of long-term medication use after elective surgical procedures.

BACKGROUND: Transitions between health care settings represent vulnerable periods for medical error. Discontinuation of long-term medication use may occur during discharge from the hospital to the community. METHODS: We performed a population-based, cohort study using administrative records from Ontario, Canada, between April 1, 1997, and September 30, 2002. We studied all residents 66 years and older with continuous use of warfarin, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), or beta-blocker ophthalmic drops for 1 or more years. Those who had an overnight hospitalization for selected elective surgical procedures were compared with 2 control groups: one that had an ambulatory procedure and one that had no procedures. All groups were assessed for the outcome of failure to renew the prescription within 6 months. RESULTS: Rates of drug treatment discontinuation after overnight hospitalizations, after ambulatory procedures, and after no procedures were 11.4%, 7.5%, and 4.8%, respectively, in the warfarin group; 4.0%, 3.9%, and 3.9%, respectively, in the statin group; and 8.4%, 8.9%, and 7.9%, respectively, in the ophthalmic drops group. The adjusted odds ratio (OR) was 2.6 (95% confidence interval [CI], 2.0-3.4) for discontinuation of warfarin therapy after overnight hospitalizations and 1.6 (95% CI, 1.4-1.7) after ambulatory procedures. In contrast, there was no increased risk of discontinuing treatment with either statins (OR for overnight hospitalization, 1.0 [95% CI, 0.9-1.2]; OR for ambulatory procedure, 1.0 [95% CI 1.0-1.1]) or ophthalmic drops (OR for overnight hospitalization, 1.0 [95% CI, 0.8-1.5]; OR for ambulatory procedure, 1.1 [95% CI, 1.0-1.2]). CONCLUSIONS: Patients prescribed long-term therapy with warfarin were at risk for potentially unintended medication discontinuation after elective procedures. Patients prescribed statins or beta-blocker ophthalmic drops were not at increased risk.

Aged↗
PubMed2002

Temporal trends in femoral curvature and length in medieval and modern Scotland.

We measured how much the radius of the anterior curvature and the length of the femoral shaft of cadaveric bones have changed from medieval to recent times. Around 20 (x, y) coordinates of a virtual coordinate system were measured at intervals of 1.5 cm along the shaft of the femur to calculate one single radius of a virtual circle in the (x, y) plane. The median radii of curvature were 119, 141, and 158 cm for medieval, early, and late 20th century femora, respectively. Early and late 20th century femora were of similar length (45 cm), but medieval femora were shorter (43.5 cm). Femora have become not only longer but also straighter since the Middle Ages. These findings account in part for the increase in height of modern generations. Size and shape changes may have significant implications for the biomechanical response of the femur to the forces to which it is subjected in everyday life, in trauma, and following surgical intervention.

Anthropology, Physical↗
PubMed2002

Impact of industrialization: comparative study of child health in four sites from medieval and postmedieval England (A.D. 850-1859).

The morbidity and mortality profiles of 831 non-adult skeletons from four contrasting sites in medieval and postmedieval England were compared to assess whether urbanization and later industrialization, had a detrimental effect on the health of the inhabitants. Failure in the population's ability to adapt to these environments should be evident in the higher rates of mortality, retarded growth, higher levels of stress, and a greater prevalence of metabolic and infectious disease in the urban groups. Non-adult skeletons were examined from Raunds Furnells in Northamptonshire, from St. Helen-on-the-Walls and Wharram Percy in Yorkshire, and from Christ Church Spitalfields in London. Results showed that a greater number of older children were being buried at the later medieval sites and that the skeletal growth profiles of the medieval urban and rural children did not differ significantly. A comparison of the growth profiles of St. Helen-on-the-Walls (urban) and Spitalfields (industrial) showed that the Spitalfields children were up to 3 cm shorter than their later medieval counterparts. At Spitalfields, cribra orbitalia and enamel hypoplasias occurred during the first 6 months of life, and 54% of the non-adults had evidence of metabolic disease. It is argued that differences in the morbidity and mortality of non-adults from urban and rural environments did exist in the past, but that it was industrialization that had the greatest impact on child health. Environmental conditions, urban employment, socioeconomic status, and changes in weaning ages and infant feeding practices contributed to differences in health in rural, urban, and industrial environments.

Adolescent↗
PubMed1993

Cox regression models for quality adjusted survival analysis.

We develop a method for incorporating covariates as regressors in a quality adjusted survival analysis (Q-TWiST) using Cox's proportional hazards model. The standard Q-TWiST method assumes that patients progress through a series of health states which differ in quality of life. The Kaplan-Meier product limit method is used to estimate the mean duration of each state by estimating the survival curves for the health state transition times. These estimates provide the basis for quality adjusted survival analysis. In this paper, the survival curves are modelled using Cox's proportional hazards regression. Quality adjusted survival is estimated given sets of covariate values, allowing one to profile patients. The results are useful for investigating how prognostic factors affect treatment benefits in terms of quality of life. We give a brief review of the standard Q-TWiST method and illustrate the extended methodology with an example from the International Breast Cancer Study Group Trial V comparing short duration versus long duration chemotherapy in the treatment of node-positive breast cancer.

Antineoplastic Agents↗
PubMedDate not supplied

Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk.

BACKGROUND: Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol. METHODS: Cardiovascular risk factor surveys have been carried out in Finland from 1972 to 1992 at 5-year intervals. Dietary surveys were carried out in connection with these surveys in 1982 and 1992. An earlier, representative dietary survey carried out in 1969-1972 was used as the baseline measure for diet. RESULTS: The total fat content of the Finnish diet changed from 38% of energy to 34%, saturated fat from 21 to 16%, and polyunsaturated fat from 3 to 5% and the intake of cholesterol decreased by 16%. Based on Keys equation these changes could have decreased serum cholesterol level by 0.6 mmol/liter (23 mg/dl) in both genders. A shift from boiled to filtered coffee could have further decreased serum cholesterol by 0.3 mmol/liter (11 mg/dl). Thus, these changes together could explain the total change in serum cholesterol, which has been on average 1.0 mmol/liter (38 mg/dl). Several other changes in the diet have also been favorable. Fruit and vegetable consumption has increased two- to three-fold during this time period. Supplementation of fertilizers with selenium since 1985 has tripled the intake of selenium. CONCLUSIONS: Dietary changes seem to explain the decrease in serum cholesterol. Together with a decline in smoking among males as well as better blood pressure control they have contributed to the dramatic decline in coronary heart disease mortality in Finland.

Adult↗
PubMedDate not supplied

Changing smoking patterns and mortality from chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is the result of many years of accelerated decline in lung function in susceptible cigarette smokers. Although risk factors for the susceptibility of smokers to COPD have been established, there are still large gaps in our knowledge of the biological basis for these risk factors and of how to identify individuals at risk. COPD is the fourth leading cause of death and, in contrast to other major chronic diseases in the United States, has not shown declines in mortality over the past 20 years. Mortality trends reflect patterns of initiation of cigarette smoking that occurred 30 to 50 years previously. Current mortality trends indicate that COPD mortality may be leveling off among white males, but will continue to increase among women, African-Americans, and the elderly. Recent studies indicate that early identification of individuals with airflow obstruction and smoking intervention can halt the progression of COPD, but widespread screening and intervention programs have not yet been established.

Adult↗
PubMedDate not supplied

Changing mortality from coronary heart disease among smokers and nonsmokers over a 20-year interval.

A comparison of coronary heart disease (CHD) mortality in two large American Cancer Society studies, Cancer Prevention Study (CPS) I (1959-1965) and CPS-II (1962-1968) suggests that surprisingly large declines occurred in two groups so defined to minimize the influence of change of smoking status. CHD mortality fell essentially in half when comparing nearly 300,000 persons who were actively smoking cigarettes at entry into CPS-I with about 228,000 persons who were similarly actively smoking at entry into CPS-II, about 20 years later. CHD mortality also declined by more than 50% among nearly half a million lifelong nonsmokers recruited for CPS-I in the early 1960s and for CPS-II in the mid-1980s. Possible explanations for these large declines include unmeasured decreases in smoking related to trial design, errors in ascertainment of causes of death, greater improvement among smokers of other risk factors for CHD, and changes in cigarettes or the pattern of smoking that have been salutary for CHD, but not for lung disease or lung cancer; none of these putative explanations can be supported by data from these studies. CHD mortality, much lower in absolute terms in recent years, is still much higher among smokers vs nonsmokers, so that the beneficial trends observed from CPS-I to CPS-II should stimulate further exploration of how CHD is related to smoking, and not serve as an excuse to ignore continued smoking.

Adult↗
PubMed1999

Primordial prevention of cardiovascular disease risk in The Netherlands.

Developments about cardiovascular disease (CVD) risk factors in The Netherlands since the 1970s are described in relation to health policy. The prevalence of hypercholesterolemia, hypertension, and obesity changed little in the 1970s and 1980s. In recent years, however, the prevalence of hypercholesterolemia tended to decrease and that of obesity to increase. The prevalence of hypertension remained stable but the percentage of treated hypertensives declined since 1987. Between 1958 and 1993 the percentage of male smokers decreased from 90% to about 40%. In women the percentage of smokers decreased from about 40% in 1975 to about 30% in 1993. Between 1987 and 1992 the intake of saturated fat decreased from 16.5 to 14.1% of energy. But during that period the intake of vegetables also decreased from 144 to 128 g/day and that of fruits from 125 to 114 g/day. Recent surveys show that up to age 65, approximately 25% of the Dutch population is physically inactive. This percentage increases sharply after age 65. Health policy for primordial prevention of CVD in The Netherlands is aimed at reduction of smoking prevalence, improvement of dietary habits, and promotion of physical activity.

Cardiovascular Diseases↗
PubMed1989

Effect of selective 5HT3 antagonist (GR 38032F) on small intestinal transit and release of gastrointestinal peptides.

Antagonists of 5-hydroxytryptamine type 3 (5HT3) receptors reduce the nausea induced by cisplatinum, but the effects of these agents on 5HT3 receptors in the human gut remain to be defined. We examined the actions of one of these drugs (Glaxo GR 38032F) on small intestinal transit and mouth-to-cecum transit times in healthy man. We also quantified its effects on the release of peptide YY (PYY), neurotensin, human pancreatic polypeptide, gastrin-cholecystokinin, and motilin. Ten healthy volunteers were enrolled in a randomized, double-blind, placebo-controlled crossover study. Following a single intravenous dose of GR 38032F (0.15 mg/kg), we measured the time to appearance in plasma of sulfapyridine after injection of salicylazosulfapyridine into the duodenum. This was used as a measure of duodenocecal transit. The appearance of hydrogen in breath after ingestion of a meal containing lactulose was also correspondingly used to quantify the mouth-to-cecum transit of the "head" of the meal. Gastrointestinal hormones were assayed in plasma by specific RIAs; samples were drawn fasting (10 min after injection) and after breakfast (358 calories: 15.7 g protein, 55.4 g carbohydrate, 8.1 g fat). The postprandial integrated response and peak release of PYY was decreased by GR 38032F. There was also a trend for the peak release of neurotensin to be reduced. GR 38032F did not significantly alter small intestinal transit times or mouth-to-cecum transit times. We conclude that GR 38032F does not have a major effect on small intestinal transit in health.

Adult↗
PubMed2003

Quality of life after subtotal colectomy for slow-transit constipation: both quality and quantity count.

PURPOSE: Subtotal colectomy reliably increases bowel-movement frequency in patients with slow-transit constipation, but its impact on quality of life is unknown. The purpose of this study was to assess the relationship between functional outcomes and quality of life after subtotal colectomy for slow-transit constipation. METHODS: We reviewed the charts and operative reports of all patients who underwent subtotal colectomy for slow-transit constipation from January 1992 to June 2001. We sent them a 54-question survey that inquired about bowel function and included a modified 36-item gastrointestinal quality-of-life index. Using Pearson's R, we correlated gastrointestinal quality-of-life index scores with specific functional outcomes. RESULTS: Of 112 patients (109 females), 28 had been lost to follow-up and 2 had died. In all, 75 surveys (67 percent) were returned. Most of these 75 patients (81 percent) were at least somewhat pleased with their bowel-movement frequency, but 41 percent cited abdominal pain; 21 percent, incontinence; and 46 percent, diarrhea at least some of the time. The overall mean gastrointestinal quality-of-life index score was 103 +/- 22 of a maximum possible score of 144 (mean score for healthy controls, 126 +/- 13). We found no correlation between frequency of bowel movements and gastrointestinal quality-of-life index score (R = -0.03). Abdominal pain, diarrhea, and incontinence each had a statistically significant negative impact on gastrointestinal quality-of-life index scores (P = 0.01). Patients who required permanent ileostomy had low gastrointestinal quality-of-life index scores (68 +/- 24). The vast majority (93 percent) of patients stated they would undergo subtotal colectomy again if given a second chance. CONCLUSION: Subtotal colectomy for slow-transit constipation increases bowel-movement frequency; however, the persistence of abdominal pain and the development of postoperative incontinence or diarrhea adversely affect quality of life. Although most patients in the present study were satisfied with their results, quality-of-life scores should be used to assess postoperative outcome.

Abdominal Pain↗