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PubMed1995

Nursing home residents: a multivariate analysis of their medical, behavioral, psychosocial, and service use characteristics.

BACKGROUND: Elderly residents of nursing homes often have multiple comorbidities and functional limitations. The status of 4,525 residents of complex and standard care units in 177 nursing homes where the nursing home was determined to provide adequate care, and from 14 specialized Alzheimer's units, was evaluated on 111 measures of medical condition, functional status, psychological well-being and cognitive performance in a demonstration study assessing quality of care in six states. Detailed measurements were also made of the types and amounts of services used (in minutes per day) by the residents. METHODS: Given the number of health measures, and the possibility of assessment error, a multivariate analytic procedure called Grade of Membership (GoM) was used. This procedure identified profiles of health and functioning measures to identify the characteristics of clinically distinct groups of nursing home residents. RESULTS: The analysis identified 11 profiles of health and functioning characteristics which described the 111 resident measurements. The 11 profiles predicted differentials in nursing home length of stay, and service use by various classes of caregivers. The GoM profiles described the data better than several other classification procedures applied to the same data. CONCLUSIONS: In nursing homes, elderly and oldest-old residents often have multiple comorbidities and disabilities. A multivariate procedure was able to identify the fundamental dimensions describing residents' variation on a number of health measures. These profiles predicted differences in service use so they had predictive validity. Thus, multivariate procedures may help identify clinically distinct groups in studies where complex measures are made.

Aged↗
PubMed2001

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes.

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.

Attitude of Health Personnel↗
PubMedDate not supplied

Teaching headache in America: survey of neurology chairs and residency directors.

OBJECTIVE: To determine the status of headache education in American medical schools and Neurology Residency Training Programs. METHODS: One hundred and thirty-three programs were identified using the Association of University Professors of Neurology listing. Two hundred and seventeen surveys were mailed to departmental chairs (DC) and residency training directors (RTD) with fax back response sheets enclosed. Two additional mailings were sent to nonresponders. Questions regarding the presence of medical school or resident educational opportunities in headache medicine including lectures and electives were included. Additional questions were asked to assess beliefs about headache education in America. RESULTS: One hundred nineteen surveys were returned. Ninety-five institutions responded including 75 Chairs and 44 RTD. Eighty percent of institutions have formal medical school lectures in headache/migraine. Fifty-five institutions claim to have a headache clinic, 52 within neurology departments. Thirty-two percent offer a headache elective to medical students. Nearly all departments offer formal resident lectures in headache/migraine, and 57% offer a headache elective. Essentially, all individual respondents believe that migraine is a valid neurological disorder and an important subject to teach in medical school. Ninety-one agree or strongly agree that headache is an important public health issue. Twenty-nine percent agree or strongly agree that headache diagnosis and management is adequately taught. Eighty-four percent believe the pharmaceutical industry has influenced migraine education and management. No important differences in response were found between Chairs and RTD. CONCLUSIONS: This survey provides the first comprehensive assessment of the status of headache medicine education in academic departments of neurology.

Data Collection↗
PubMedDate not supplied

Nutritional and cognitive status in elderly subjects living in service flats, and the effect of nutrition education on personnel.

BACKGROUND: There is limited knowledge about the nutritional and cognitive status in elderly and chronically ill subjects living in sheltered housing. OBJECTIVE: To perform a 6-month follow-up study in order to investigate (1) nutritional status and its relationship to cognitive function in elderly people living in service flats, and (2) the effect of a 9-hour educational program given to personnel working in the service flats. METHODS: Of 93 eligible subjects, 28 agreed to participate (age 81 +/- 7 years, 75% women). Body mass index (BMI), triceps skin fold (TSF), arm muscle circumference (AMC), appetite, Subjective Global Assessment (SGA), serum albumin, serum insulin-like growth factor-1 (IGF-1) and Mini Mental Test (MMT) were assessed on two occasions with a 6-month interval. The staff of the service flats answered a questionnaire before and 6 months after an educational program. RESULTS: At the start, BMI, TSF and AMC were within the normal ranges, e.g. BMI 26.6 +/- 3.1 for men and 25.6 +/- 3.2 for women. Three subjects were suspected to be malnourished and 2 were malnourished according to SGA. Among 20 randomly selected subjects who chose not to participate in the investigation, age, sex, BMI, weight loss and appetite were not significantly different from those values in participants. However, none of the latter had a BMI <20 compared to 10% in non-participants. The MMT results suggested cognitive dysfunction in 41% of the subjects. On the first test occasion, MMT correlated with BMI (r = 0.43, p < 0.03), weight loss (r = 0.4, p < 0.05) and age (r = -0.38, p < 0.05). The ability of the personnel to suggest suitable nutrition for fictitious patient cases appeared to have improved after the educational program. At the 6-month follow-up, the BMI in men rose to 27.0 +/- 3.4 (p < 0. 05), while other anthropometric measurements remained unchanged. Serum IGF-1 lay within the normal range, as did serum albumin which, however, rose from 39.1 +/- 2.9 to 41.2 +/- 3.5 g/l (p < 0.01). CONCLUSION: Fifteen to twenty percent of the individuals studied in the service flats displayed definite or possible signs of malnutrition. Cognitive function correlated with BMI, weight loss and age. The educational program appeared to increase the nutritional knowledge in personnel working in the service flats. At the 6-month follow-up, the nutritional status of the residents had not deteriorated.

Activities of Daily Living↗
PubMed2002

Mental health and the built environment: cross-sectional survey of individual and contextual risk factors for depression.

BACKGROUND: Little is known about the effects of the physical environment on individual health. AIMS: The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings. METHOD: Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES-D). The built environment was rated independently, using a validated measure. RESULTS: After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% CI 1.03-1.58; P=0.02) and of recent (post-1969) construction (odds ratio=1.43, 95% CI 1.06-1.91; P=0.02). CONCLUSIONS: The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

Adolescent↗
PubMed1982

Emotional bondedness, subjective well-being, and health in elderly medical patients.

The relationship between social interaction, as measured by a new Emotional Bondedness Scale, health, and subjective well-being were examined in 205 ambulatory medical patients aged 65 to 98 (M = 71.2 years). Health was measured by a Self-Rated Health Scale, a Physician-Rated Health Scale, the Sickness Impact Profile, and the Zung Self-Rating Depression Scale. Subjective well-being was measured by the Life Satisfaction Index--A and the Affect Balance Scale. A significant correlation was found between emotional bondedness, health, and subjective well-being. Multiple regression analyses revealed that emotional bondedness is a significant predictor of subjective well-being and self-rated health. The variables age, marital status, type of residence, and income were not significantly correlated with either measure of subjective well-being. This study suggests that emotional bondedness has a direct impact on and is closely associated with health and subjective well-being in elderly medical patients.

Aged↗
PubMed2002

Urban residential environments and senior citizens' longevity in megacity areas: the importance of walkable green spaces.

STUDY OBJECTIVES: To study the association between greenery filled public areas that are nearby a residence and easy to walk in and the longevity of senior citizens in a densely populated, developed megacity. DESIGN: Cohort study. METHODS: The authors analysed the five year survival of 3144 people born in 1903, 1908, 1913, or 1918 who consented to a follow up survey from the records of registered Tokyo citizens in relation to baseline residential environment characteristics in 1992. MAIN RESULTS: The survival of 2211 and the death of 897 (98.9% follow up) were confirmed. The probability of five year survival of the senior citizens studied increased in accordance with the space for taking a stroll near the residence (p<0.01), parks and tree lined streets near the residence (p<0.05), and their preference to continue to live in their current community (p<0.01). The principal component analysis from the baseline residential environment characteristics identified two environment related factors: the factor of walkable green streets and spaces near the residence and the factor of a positive attitude to a person's own community. After controlling the effects of the residents' age, sex, marital status, and socioeconomic status, the factor of walkable green streets and spaces near the residence showed significant predictive value for the survival of the urban senior citizens over the following five years (p<0.01). CONCLUSIONS: Living in areas with walkable green spaces positively influenced the longevity of urban senior citizens independent of their age, sex, marital status, baseline functional status, and socioeconomic status. Greenery filled public areas that are nearby and easy to walk in should be further emphasised in urban planning for the development and re-development of densely populated areas in a megacity. Close collaboration should be undertaken among the health, construction, civil engineering, planning, and other concerned sectors in the context of the healthy urban policy, so as to promote the health of senior citizens.

Aged↗
PubMed1999

Healthy dietary habits in relation to social determinants and lifestyle factors.

The aim of the present study was to evaluate the importance of social status and lifestyle for dietary habits, since these factors may influence life expectancy. We studied the association of four indicators for healthy dietary habits (fruits and vegetables, fibre, fat and Hegsted score) with sex, age, socio-economic status, education, physical leisure exercise, smoking and personal attention paid to keeping a healthy diet. Data were gathered with a self-administered quantitative food-frequency questionnaire distributed to a representative sample of Norwegian men and women aged 16-79 years in a national dietary survey, of whom 3144 subjects (63%) responded. Age and female sex were positively associated with indicators for healthy dietary habits. By separate evaluation length of education, regular physical leisure exercise and degree of attention paid to keeping a healthy diet were positively associated with all four indicators for healthy dietary habits in both sexes. Socio-economic status, location of residence and smoking habits were associated with from one to three indicators for healthy dietary habits. In a multiple regression model, age, education and location of residence together explained from 1 to 9% of the variation (R2) in the four dietary indicators. Length of education was significantly associated with three of four dietary indicators both among men and women. By including the variable 'attention paid to keeping a healthy diet' in the model, R2 increased to between 4 and 15% for the four dietary indicators. Length of education remained correlated to three dietary indicators among women, and one indicator among men, after adjusting for attention to healthy diet, age and location of residence. Residence in cities remained correlated to two indicators among men, but none among women, after adjusting for age, education and attention to healthy diet. In conclusion, education was associated with indicators of a healthy diet. Attention to healthy diet showed the strongest and most consistent association with all four indicators for healthy dietary habits in both sexes. This suggests that personal preferences may be just as important for having a healthy diet as social status determinants.

Adolescent↗
PubMed2001

[Evaluation of plain abdominal radiography prescriptions in a university hospital center].

OBJECTIVES: The aim of this study was to evaluate the prescription, impact and diagnostic utility of plain abdominal radiography in a University Hospital. METHODS: Plain abdominal radiography series performed over 15 consecutive days were evaluated for quality and agreement with the patient's clinical status. Agreement between the final diagnosis and the radiographic findings were also compared. Contribution of plain abdominal radiography to final diagnosis was assessed on the basis of the conclusions on the hospital discharge report or from those drawn from a telephone survey. The same relationship was also assessed in terms of clinician status (medical student, resident physician, senior physician). RESULTS: The series included 175 radiography series (11.6 per day). In 86% of the cases, the choice of views was adapted to the clinical context. In 14% it was not. The quality of the x-rays was found to be unsatisfactory in 17%, good in 63% and excellent in 20%. The radiography was considered to be contributive to the final diagnosis in 13% of the cases and non-contributive in 87%. Clinician status was not correlated with the degree of usefulness for final diagnosis. Finally, the prescription was in agreement with standard guidelines in 28% of the cases and not in agreement in 72%. CONCLUSION: Plain abdominal radiographs are neither sensitive nor specific, frequently misleading, and costly per specific and correct diagnosis. Better physician awareness is required to limit the number of unnecessary examinations.

Abdomen↗
PubMed2003

Dietary and nutritional patterns in an elderly rural population in Northern and Southern Italy: (I). A cluster analysis of food consumption.

OBJECTIVE: To describe the food consumption patterns of Italian elderly subjects and the factors associated with different dietary habits. DESIGN: Cross-sectional study. SETTING: Population-based study. SUBJECTS: A total of 847 men and 1465 women aged 65 y or older, living in rural areas in the province of Pavia (Northern Italy) and near Cosenza (Southern Italy) in 1992-1993. INTERVENTIONS: The dietary information was collected by means of a quantitative food-frequency questionnaire, with cluster analysis being used to segregate the subjects on the basis of similarities in their food consumption. A generalised logistic regression model including residence, age, living status, education, physical activity and degree of disability was fitted to assess the factors associated with different food consumption habits. RESULTS: Six dietary clusters were selected for men and seven for women. The largest cluster for both genders was "small eaters" (46% of men and 51% of women); "big eaters", "light diet" and "alcohol" clusters were also identified for both genders. The men were also grouped into "balanced diet" and "cheese" clusters, and the women into "sweet", "greens" and "butter" clusters. CONCLUSIONS: In addition to the influence of the area of residence--residents in Northern Italy consume greater amounts of animal fats, sugar and alcoholic beverages, and those living in Southern Italy have a greater intake of fruit, vegetables, fish and olive oil--all of the other studied variables predicted the probabilities of falling into a specific dietary cluster. SPONSORSHIP: National Research Council (Italy)--Invecchiamento Project No. 95.01048. PF40.

Aged↗
PubMed1987

Prediction and profile of the long-stay population. A nation-wide cohort of first time admitted patients.

A nation-wide cohort of 12,737 first admitted patients aged 15 years or more to Danish psychiatric institutions was followed in the Danish Case Register for a 10-year period. Long stay patients were delineated as: 1) patients whose first admission lasted for more than 1 year (new long-stay); or 2) patients who later had an admission lasting for more than 1 year (late long-stay). Together they comprised 420 males and 527 females with an incidence rate of 0.22 males and 0.27 females per 1,000. Up to age 65 males dominated, after 65 females dominated. Thirty-three percent of demential disordered and 24 of schizophrenics became long-stay patients. A multiple contingency analysis showed that the variables "age group", "main diagnosis", "size of municipality of residence" and "marital status" were independently associated with the outcome "long-stay". The two long-stay groups differed. New long-stay patients tended to be females, older, suffering from demential disorders and with a total hospital stay shorter than that of the long-stay population. In a multiple contingency analysis the variables "age group" and "main diagnosis" were independently associated with the outcome "new long-stay" and the variables "age groups", "main diagnosis" and "size of municipality of residence" with the outcome "late long-stay".

Adolescent↗
PubMed1990

Prevalence and need for replacement of amalgam and composite restorations in Dutch adults.

In 1986, the first nationwide epidemiological survey of adult oral health and attitudes to oral health care was carried out in The Netherlands. One of the aims of this study was to evaluate the prevalence and the quality (in terms of need for replacement) of amalgam and composite restorations in the Dutch adult population. A group of 600 dentate individuals, 20-44 years of age, was examined. Stratified cluster sampling included as factors age, gender, socio-economic status, and area of residence. Two additional parameters were studied: frequency of visiting a dentist and type of health insurance. Oral examinations consisted of direct (mirror and explorer) and indirect (color slides and bite-wing radiographs) observations with use of well-defined criteria. On average, 13.4 restorations per individual were present, of which 23.3% were classified as unsatisfactory. A great difference in prevalence and quality data was found among several types of restorations. Test results (ANOVA) for effects of age, gender, socio-economic status, area of residence, frequency of visiting a dentist, and insurance on the prevalence of (un)satisfactory restorations resulted nearly always in significant effects of only age and frequency of visits to a dentist. There was a tendency (p less than 0.05) for the prevalence of (un)satisfactory restorations to be higher with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Epidemiology of pancreas cancer in Los Angeles.

The characteristics of the 3614 Los Angeles County residents in whom cancer of the exocrine pancreas was diagnosed during the period 1972-1977 were compared with those of all county residents and patients in whom any cancer was diagnosed during the same period. Seventy-nine percent of the diagnoses had been pathologically verified. This disease still preferentially afflicts the old, the black, and men, although the differences in risk with factors other than age are modest. The disease is not evenly distributed by social class, or over time, although it is not clear that the observed differences reflect etiology. The distributions with respect to important categories of occupation and industry, religion, marital status, geography of residence, and birthplace were rather uniform. Although there is no obvious explanation for any of several unexpected minor inequities in the pattern of incidence, there is no compelling evidence to support any specific environmental cause. There is substantial evidence which is inconsistent with those environmental hypotheses that have been proposed previously.

Age Factors↗
PubMed1991

The effect of nutrient supplements on high risk long term care residents receiving pureed diets.

This study assessed the change in nutritional intake and status of 15 nursing home residents receiving a pureed diet along with commercial supplements over a 6 month period. The nutritional supplements were well accepted with a significant increase in the energy and nutrient intake after their addition. Gastrointestinal distress was measured by stool size and number. The mean number of stools increased over the 6 month period with the stool sizes remaining relatively the same. Decubitus status was monitored and seven of the ten residents who had some form of decubiti demonstrated signs of complete or partial healing. After three and six months of supplementation hematocrit and serum albumin levels significantly increased.

Aged↗
PubMedDate not supplied

A population-based serosurveillance of syphilis in Costa Rica.

As part of a case-control study to investigate the high incidence of cervical cancer in Costa Rican women, the seroprevalence of the treponematoses, in particular, syphilis was determined. In each age group, women with a history of two or more sex partners were two to four times more likely to be seroreactive in tests for syphilis than women with zero or one sex partner. The highest percentage of reactive results in the microhemagglutination assay for antibodies to Treponema pallidum (MHA-TP) was seen in samples from women aged 50-59 who had had two or more lifetime partners (23.8%). Three observations from our study support reactivity due to syphilis rather than yaws or pinta: (1) a similar percent of reactive rapid plasma reagin (RPR) card test results among MHA-TP reactors in the two age groups of women who were surveyed (42 vs. 49%) was observed; (2) women who were seroreactive in the MHA-TP had multiple risk factors for STD [low socioeconomic status (9.4%), urban residence (22.8%), first intercourse under 16 years of age (14.1%), and multiple sex partners (26.3%)], and (3) only sexually experienced women had reactive results in the MHA-TP test.

Adult↗
PubMed2006

Suicide risk in relation to social class: a national register-based study of adult suicides in Korea, 1999-2001.

BACKGROUND: Few controlled studies have examined social class as a risk factor for suicide in Korea. AIM: The objective of the present study was to investigate the effects of social class on suicide risk in Korea. METHODS: A case-control design was constructed from cause-of-death statistics for the period 1999 to 2001, in Korea, as published by the Korean National Statistical Office. The cases were defined as people aged between 20 and 64 who died by suicide, while the controls were defined as those who died of natural causes in the same age groups. RESULTS AND CONCLUSIONS: The proportions and odds ratios for suicide were higher in young people than in elderly people, and higher for divorced subjects than for cohabitants. They were also higher for residents of rural areas, as opposed to residents of Seoul and other metropolitan areas, and for people in social classes III and IV, than they were for those in social class I. To control the variables that influence risk of suicide, such as age, marital status and area of residence, we used multiple logistic regression. Compared with class I, risk of suicide was higher in social classes III and IV, in both sexes. The principal conclusion of this study is that, regardless of sex, lower social class constitutes a high risk for suicide in Korea, even after controlling for variables such as age, marital status and area of residence. We conclude that a well-controlled and balanced social welfare system could reduce suicide risk, especially among people in lower social class.

Adolescent↗
PubMed1992

Frontier areas: opportunities for NPs' primary care services.

Demographers have recently designated frontier areas as distinct from other rural areas. Frontier counties are defined as those with less than six persons per square mile; as such, they constitute 45 percent of the U.S. land mass and include 2.2 million people. The health status among frontier residents is estimated to be lower than that of other rural or urban populations, and frontier health services, particularly primary care services, are scant. In this article, opportunities for nurse practitioners in frontier practice are explored, including specific suggestions for the development of new frontier NP practices.

Career Mobility↗
PubMed2006

An epidemiological study of head injuries in a UK population attending an emergency department.

We aimed to identify the attendance rate for all head injuries, and for moderate to severe head injury (MSHI), in an emergency department (ED), and related risk factors for MSHI, including age, sex, area of residence, and socioeconomic status (SES). This was a retrospective descriptive epidemiological study of an ED database of head injury attendances over 6 years, carried out in an ED that serves both urban and mixed rural and urban areas, with a wide socioeconomic range, and a total population of 344,600. The main outcome measure was rates of attendance for head injury. Head injury presentations accounted for 3.4% of all attendances per year. An overall rate of 453 per 100,000 was found for all head injuries, of which 40 per 100,000 were moderate to severe (10.9%). Urban residents had significantly greater risk of presenting with MSHI compared with residents of mixed/rural areas. Males were more at risk than females, and children and adolescents had higher risk of MSHI. A high attendance rate of MSHI was found in the <5 year old age group in urban areas for both sexes. A gradient, with higher attendance in groups with lower SES, was observed for children in urban areas, while the gradient was reversed in mixed/rural areas. Head injuries are a relatively common cause of attendance at ED. There is significant variation in attendance with MSHI with regard to sex, age, socioeconomic factors, and type of area of residence. The planning and delivery of preventative and management services may be improved by such analyses.

Adolescent↗