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PubMed1976

21. The National Center for Health Statistics; long-term care surveys.

The NCHS has been conducting ad hoc surveys of nursing homes and other long-stay institutions since 1963. Growing public concern about the quality of care in nursing homes has provided the support to expand these data collection activities and establish a biennial program, commencing with the 1973-74 Nursing Home Survey. Based on a national probability sample, the new program collects a wide range of data about the health status and demographic characteristics of residents, availability of personnel and services, facility characteristics, costs, charges, and sources of payment. Among the problems common to these surveys are the difficulties of measuring quality of care, assessing the actual cost of services or episodes of illness, classifying long-term care establishments, and adapting survey methods to measure longitudinal changes in health status of residents and the corresponding provision of services.

Costs and Cost Analysis↗
PubMed2026

Elements on the move: How ungulate migration expands Alpine biogeochemical footprints.

Through depositing waste products, animals influence the spatial distribution of elements across landscapes. Yet the relationship between animal movement and element distribution remains poorly characterized. We developed a spatially explicit agent-based model to test how migratory versus resident red deer (Cervus elaphus) influence nitrogen redistribution across an alpine landscape in the Central-Eastern Italian Alps. Specifically, we asked how both local-scale and landscape-scale movement alter the spatial extent and magnitude of nitrogen deposition. We parameterized our model with GPS telemetry from 2021 to 2024 and remotely sensed vegetation data. We simulated four different scenarios which allowed us to disentangle the relative effects of large-scale (migration persisting) and fine-scale (resident behaviour) movement: (i) mixed migratory-resident (300 deer), (ii) fully resident (300 deer), (iii) reduced resident (150 deer) and (iv) reduced migratory (150 deer). The potential for nitrogen intake, assimilation, and excretion occurred hourly across a seasonally dynamic landscape. Across all scenarios, tree cover density and slope consistently emerged as positive predictors of nitrogen transport. Thus, regardless of resident or migratory status, red deer act as mediators of local element transport. Similarly, proximity to roads/trails reduced nitrogen inputs and created closed systems, indicating that barriers constrain both local and landscape-scale element transport. Migration substantially expanded the spatial extent of nitrogen redistribution and enabled the upward movement of elements, both locally upslope and into higher elevation habitats, effectively transporting elements against gravitational forces. Consequently, the loss of migration is likely to weaken these large-scale element linkages and reduce associated ecosystem functions. Our results demonstrate that different animal movement patterns play distinct and complementary roles in connecting element pools across landscapes. While both resident and migrant foraging redistribute elements locally, migratory movements link lowland and alpine habitats, expanding the spatial reach of element redistribution. Thus, loss of migration not only reduces the spatial extent of element distribution but also alters the topographic pathways through which elements are cycled. These findings highlight the broader ecosystem consequences of declining animal movement extent, and migration in particular, and underscore the importance of conserving behavioural diversity to maintain element heterogeneity and ecosystem functioning in mountain systems.

animal ecology↗
PubMed2001

Are rural residents less likely to obtain recommended preventive healthcare services?

BACKGROUND: This study examined rural-urban differences in utilization of preventive healthcare services and assessed the impact of rural residence, demographic factors, health insurance status, and health system characteristics on the likelihood of obtaining each service. METHODS: National data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) and the 1999 Area Resource File were used to evaluate the adequacy of preventive services obtained by rural and urban women and men, using three sets of nationally accepted preventive services guidelines from the American Cancer Society, U.S. Preventive Services Task Force, and Healthy People 2010. Logistic regression models were developed to control for the effect of demographic factors, health insurance status, and health system characteristics. RESULTS: Rural residents are less likely than urban residents to obtain certain preventive health services and are further behind urban residents in meeting Healthy People 2010 objectives. CONCLUSIONS: Efforts to increase rural preventive services utilization need to build on federal, state, and community-based initiatives and to recognize the special challenges that rural areas present.

Adolescent↗
PubMed1997

Survey of management training in United States and Canadian pathology residency programs.

One hundred seventy-six United States and Canadian pathology residency programs were surveyed to assess the status of management training for residents. Specific questions in the survey concerned approaches to management, instructional methods used, topics covered, and length of management rotations. Eighty-four programs (48%) responded to the survey. This group represented a cross section of all programs as to location, size, and type of program. Of the 84 programs, 81 (96%) offered management training, while 54 programs (64%) offered a management course. Management training usually occurred in combination with other rotations, most frequently clinical pathology subspecialties. A dedicated management rotation was reported in 19 programs (23%). The most common method of instruction was apprenticeship/mentor followed by didactic lecture. A majority of programs used multiple instructional methods. The five most frequently covered topics were budgets, personnel issues, quality assurance, utilization, and instrument evaluation, but a wide variety of topics were included in management curricula surveyed. There was an emphasis on clinical laboratory administration. Nonpathologist instructors, such as medical technologists, hospital administrators, and business executives, were used for formal didactic exercises, while teaching by pathologists occurred predominantly by mentoring during clinical pathology rotations.

Administrative Personnel↗
PubMedDate not supplied

Appropriateness of hospital use by family physicians.

BACKGROUND: Reducing inappropriate hospital admissions could lead to lower total health care costs without compromising the quality of care. Research suggests that a sizeable portion of hospital admissions are inappropriate. Other studies indicate that family physicians use health care resources, including hospitalizations, less often than other primary care physicians. To gain additional insight into family physicians' decisions to admit patients, we performed an exploratory study using the Appropriateness Evaluation Protocol, a validated, clinically based utilization review instrument. METHODS: We assessed admissions by community-based and residency-based family physicians to a single university-affiliated hospital during calendar year 1988. A total of 905 patients were admitted to the hospital by family physicians during the study period. Of these, 889 records had complete data. Each was reviewed for appropriateness of admission. We calculated percentages of inappropriate admissions and used logistic regression to ascertain variables that were significant predictors of inappropriateness. RESULTS: Overall, 5.4 percent of admissions were categorized as inappropriate. Omitting obstetric cases, the rate was 10.5 percent. Inappropriate admissions did not cluster around a small number of diagnoses or diagnosis-related groups. Using logistic regression, we found that urgency of admission, patient insurance status, and residency-based physician admission versus community-based physician admission were significant predictors of inappropriate hospital use. Of the inappropriate admissions, 70 percent were so rated because diagnostic procedures or treatments could have been performed on an outpatient basis. CONCLUSIONS: In contrast with other studies for which physician specialty was not controlled, family physicians less frequently admitted patients inappropriately. Predictors of inappropriateness differed from those found in other studies. Changes in hospital systems, in addition to educational efforts directed toward individual physicians, hold promise as a strategy for reducing inappropriate hospital use.

Adult↗
PubMed1994

Selenium status in Turkey. II. Serum selenium concentration in healthy residents of different ages in Ankara.

In this study we determined the serum selenium concentraction of 218 healthy individuals at different ages, in Ankara, using a spectrofluorimetric method. The mean selenium levels were found to be 45 +/- 10 micrograms/L in cord blood at birth; 69 +/- 13 micrograms/L in 2 month-12 month-old infants; 77 +/- 12 micrograms/L in children aged > 12 months-16 years; and 74 +/- 16 micrograms/L in adults aged 18-48 years. Selenium concentrations showed age dependency, increasing significantly in childhood but decreasing after 40 years of age. No relation to the sex, dietary habits, socioeconomical status or hematological parameters such as hemoglobin concentration and white blood cell count, was observed. The results obtained thus suggest that the status of selenium in Ankara residents is in a range that could be considered as safe and adequate.

Adolescent↗
PubMed2000

Social inequalities, stressors and self reported health status among African American and white women in the Detroit metropolitan area.

This article examines the cumulative effects of multiple stressors on women's health, by race and area of residence. Specifically, we examine socioeconomic status, experiences of unfair treatment and acute life events by race and residential location, and their cumulative effects on the health status of African American and white women living within the city of Detroit and in the surrounding metropolitan area. African American women, regardless of whether they live inside or outside the city, report more frequent encounters with everyday unfair treatment than white women. African American women who live in the city report a greater number of acute life events than white women who live outside the city. Regression analyses used to examine the cumulative effects of exposure to these stressors by race and area of residence show that: (1) socioeconomic status, everyday experiences with unfair treatment and acute life events each make a significant contribution to differences in health status; and (2) the contribution of each of these variables to explaining variations in health status varies by area of residence. We suggest that differences in socioeconomic status, exposure to unfair treatment or discrimination and experiences of acute life events make significant contributions to racial differences in women's health status.

Adolescent↗
PubMed2006

Prognostic importance of palpability as a feature of screen-detected breast cancers.

OBJECTIVES: To determine epidemiological characteristics of palpability as a feature of asymptomatic invasive breast cancers detected through screening mammography, and to determine whether palpability is predictive of case survival after adjusting for conventional prognostic indicators such as diameter, grade and nodal status. SETTING: The University of Adelaide, South Australian Department of Health, and The Cancer Council South Australia, Adelaide, South Australia. METHODS: Sociodemographic and clinical characteristics of 2108 screen-detected invasive breast cancers were compared by tumour palpability using univariate and multiple logistic regression analysis. Survival outcomes from breast cancer were compared using Kaplan-Meier product-limit estimates. Multivariable proportional hazard regression was employed to assess the association of palpability with survival after adjusting for conventional prognostic indicators. RESULTS: Palpability was associated with year of diagnosis, ductal histology type, and unfavourable prognostic indicators such as larger tumour diameter, higher grade and nodal involvement. After adjusting for these variables, no associations were found with age at diagnosis, place of residence or socioeconomic status, or with presence of multifocal disease or presence of an extensive in situ component. Palpability was predictive of death from breast cancer in an unadjusted analysis, the relative risk (95% confidence limits) being 1.75 (1.12, 2.74). After adjusting for nodal involvement and larger tumour size, the relative risk no longer was elevated, reducing to 0.99 (0.60, 1.64). DISCUSSION: Palpability is associated with unfavourable prognostic indicators, such as larger diameter, higher grade and nodal involvement, and is not an independent indicator of survival outcome for screen-detected female-breast cancers after accounting for nodal involvement and diameter.

Adult↗
PubMed1994

Residential radon exposure and lung cancer: evidence of an urban factor in Iowa.

An ecological study of lung cancer, cigarette smoking, and radon exposure was conducted in 20 Iowa counties. County-based lung cancer incidence data for white female residents of Iowa were stratified according to radon level and smoking status. Cancer incidence data for the period 1973-1990 were obtained from the State Health Registry of Iowa. Smoking level was determined from a randomly mailed survey. Radon level was determined according to an EPA supported charcoal canister survey. Within low smoking counties, rates for all lung cancer and small cell carcinoma were significantly lower (p < 0.05) in the high radon counties relative to the medium and low radon counties. However, within high smoking counties, rates for all lung cancer, adenocarcinoma, and small cell carcinoma were significantly higher (p < 0.05) in the high radon counties relative to the low radon counties. Variations in socioeconomic data for these counties, available through the 1980 and 1990 census, did not explain these results. Lung cancer rates also were significantly increased in urban counties even after holding smoking status constant. Multivariate analyses revealed significant interactions between smoking, urbanization, radon levels, and lung cancer. The results of this hypothesis generating study will be tested in a case/control study now ongoing in Iowa. Analysis will need to include separate evaluations by smoking status, radon level, and residence in urban or rural areas for the major morphologic types of lung cancer.

Adenocarcinoma↗
PubMed2003

[Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing].

OBJECTIVE: To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population. METHODS: In 1992, a cohort of 3257 people > or = 55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively. RESULTS: The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH (HR = 1.12, 95% CI: 0.93 - 1.35) and poor SRH (HR = 1.53, 95% CI: 1.25 - 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 (HR = 2.25, 95% CI: 1.67 - 3.04) and 2.22 (HR = 2.22, 95% CI: 1.61 - 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases. CONCLUSIONS: The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.

Activities of Daily Living↗
PubMed1997

Access to health care. Part 1: Children.

OBJECTIVES: This report presents national estimates of access to medical care and unmet health care needs for children through 17 years of age by selected sociodemographic variables including sex, age, race and/or ethnicity, family income, family structure, place of residence, and health status. In addition, the impact of children's health insurance status on access to care is described. METHODS: Data from the 1993 Access to Care and Health Insurance questionnaires of the National Health Interview Survey (NHIS) are analyzed to examine access indicators. The NHIS is a continuing household survey of the civilian noninstitutionalized population of the United States. The sample included 16,907 children from infants through 17 years of age from 24,071 households. RESULTS: In 1993, over 7.3 million U.S. children had at least one unmet health care need or had medical care delayed because of worry about the cost of care. These health care needs included medical care, dental care, prescription medicine, glasses, and mental health care. In addition, almost 4.2 million children lacked a regular source of health care. Factors related to access indicators included health insurance, family income, race and/or ethnicity, family structure, and place of residence. The lack of health insurance or inability to afford care was the main reason given by respondents for children lacking a regular source of medical care. CONCLUSIONS: In the United States, millions of children do not receive needed health care services. Uninsured children and those in families with low income are at the greatest risk of having unmet health needs.

Adolescent↗
PubMedDate not supplied

Thoughts on malaria in pregnancy with consideration of some factors which influence remedial strategies.

There is evidence that pregnancy enhances the clinical severity of malaria, especially of P. falciparum infections. In pregnant women with little or no prior experience of the disease, P. falciparum causes severe clinical illness, substantial malaria mortality, increased rates of abortion and stillbirth and low birthweight of offspring; moreover, in such women, the clinical consequences seen unmodified by maternal parity. However, in pregnant women resident in highly endemic areas who have acquired considerable immunity through prolonged prior contact with malaria, parity appears to influence susceptibility to an important degree. Women who are pregnant for the first time are most affected, showing increased prevalence and density of parasitaemia, increased frequency of clinical illness (but not mortality) and significantly increased frequency of delivery of low birthweight children. In contrast, in multigravid women these clinical features are much less obvious and rarely attain statistical significance. The differences in susceptibility to malaria of pregnant women associated with parity and previous immunological experience require that protective strategies must be planned with full knowledge of the local epidemiology of malaria and be specifically targeted to the women who require them. Furthermore, the effectiveness of each strategy requires careful monitoring to permit such modifications as may be required by change in the immune status of the resident population.

Adolescent↗
PubMed1991

Health status of hostel dwellers. Part VI. Tobacco smoking, alcohol consumption and diet.

Smoking, alcohol consumption and diet were among the criteria selected to screen health status among the residents of the urban migrant council-built hostels of Langa, Nyanga and Gguletu outside Cape Town. Smoking patterns fell within the range found elsewhere. Problems associated with alcohol consumption were exacerbated by the overcrowded hostel living conditions. Dietary patterns were not examined against the concept of an 'ideal diet'. They are understood in the context of the poverty of the hostel dwellers and in the context of limited space available in the hostel environment for cooking and storage. In comparison with a home-based migrant population, the urban migrant hostel dwellers eat more frequently, more regularly and have more variety in their diet. In the light of the findings on the lifestyle indicators of the hostel dwellers, it is concluded that improved living conditions, rather than health education that focuses on individual behaviour, will have a greater impact on improvements in their health status.

Adolescent↗
PubMed1993

[Health status of children and adolescents in the main cotton growing region of Central Asia].

The paper outlines the health status of schoolchildren residing in a rural area of Uzbekistan. It also provides the results of an analysis of the pupils' morbidity rates by age, sex, pattern of chronic diseases and extent of their spread. The high proportion of nervous and mental diseases concurrent with headache is associated with chronic pesticide intoxication. It is concluded that there is a need of a wide range of health promotion measures, removal of some poor exogenous factors, and improvement of socioeconomic living conditions of the Uzbekistan's rural population.

Adolescent↗
PubMed1993

Composite indicators of dental health: functioning teeth and the number of sound-equivalent teeth (T-Health).

This study investigated whether two new composite dental indicators--"the number of functioning teeth" and "the number of sound-equivalent teeth"--are more efficient than the conventional DMFT index in revealing the social and behavioural factors which are significantly related to oral health status. The arbitrary set of weights given to the T-Health indicator was also evaluated. The number of functioning teeth was defined as the aggregate of filled (otherwise sound) and sound teeth. The T-Health was defined as a weighted average of sound teeth, filled (otherwise sound) teeth and teeth with some decay, the weights intended in principle to represent the relative amounts of sound tissue in these three categories of teeth. An arbitrary set of weights was used: 4, 2, and 1 for sound, filled, and decayed teeth, respectively. 164 families (father, mother and at least one 13-yr-old child) from Belo Horizonte, Brazil, were randomly selected from 13-yr-old children from private and state schools. The parents' ages ranged from 35 to 44 yr. Socio-economic status, area of residence, level of education, family income, sugar consumption, toothbrushing frequency and type of dental attendance were the social and behavioural oral health risk-factors considered in this study. The results indicated that the two new dental indicators are more sensitive to the influence of social and behavioural factors, such as those investigated here, than is the traditional DMFT index. A different set of weights (4, 1, and 1 for sound, filled, and decayed) was suggested for the construction of the T-Health.

Adolescent↗
PubMed1996

Minor psychiatric morbidity and internal migration in Brazil.

Studies of non-psychotic disorders in migrants have shown inconsistent results. This paper reports the findings of a case-control study carried out in three cities in Brazil to investigate the association between migration and minor psychiatric morbidity (MPM). Two hundred and seventy-six cases and 261 controls were selected from a survey of 6740 people aged 15 years or more. Diagnoses were made using the DSM-III Symptom Checklist. A statistically significant increase in risk of MPM in migrants was found by univariate analysis [odds ratio (OR) = 1.76; 95% confidence interval (CI) = 1.21-2.57. After controlling for gender, age, educational level, marital status, place of residence and position in the labour market, the overall increase in risk of MPM disappeared (OR = 1.02; 95% CI = 0.64-1.64), but a statistically significant increase in risk was present only in migrant unemployed women. This finding did not support models that explain risk in migrants by viewing migration as associated with cultural change and stressful life events. On the other hand, models based on the concept of selection- displacement from the labour market are more consistent with the present findings.

Adolescent↗
PubMed2002

Factors associated with self-reporting of chronic health problems in the French GAZEL cohort.

The objective of this study was to examine factors associated with self-reporting of chronic health problems. The self-reports were obtained from a questionnaire sent by mail to the French GAZEL cohort, composed of workers of a French company. The disorders reported in the questionnaire were compared with diagnoses from the sick-leave database of the company. Associations between self-reporting and characteristics were studied by multiple logistic regression analyses. Three types of characteristics were analyzed: individual, methodological and disorder-related (i.e., prevalence of chronic disorders in the general population, probable disability and probable life risk scores). In 1992, the cohort consisted of 16,534 subjects aged 38 to 53 years. The reporting rate (number of self-reports in the questionnaire divided by number of records in the sick-leave database for the disorder considered) varied from 8.9% to 100%. Self-reporting was associated with individual characteristics (gender, family status, place of residence, annual number of sick days and sick leaves), disorder-related characteristics (probable disability, prevalence) and methodological characteristics (precision of the formulation, delay between the last sick-day and the patient report). By body system, the characteristics associated with self-reporting varied greatly but the annual number of sick days, probable disability and precision of formulation were the variables which remained most often in the models. These characteristics should be particularly taken into consideration in the interpretation of epidemiological results based on self-reporting.

Adult↗
PubMed1999

[Survey on the current status of drinking water supply, latrines and the health knowledge of residents in the remote rural areas of several provinces of China].

A survey on the current status of drinking water supply, latrines and the health knowledge of residents in the remote rural areas of the southwest and northwest of China was reported. A stratified cluster sampling method was adopted in the survey. 83 poverty countries and 74,900 families were involved in the survey and four hundred thousands data were obtained by home visiting. The results showed that the coverage of rural latrines, sanitary latrines and safe night-soil disposal in the surveyed regions had reached 90.0%, 6.0% and 25.0% of populations respectively. The coverage of safe-drinking water was 57.6% of homes and no adequate supply of drinking water was 13.2% of homes; Many responders in the survey did not have the knowledge related to intestinal infectious diseases. There were 42.3% of them not knowing that night-soil was the source of infectious diseases, 56.2% of them not knowing that fly could spread infectious diseases and 70.0%-82.7% of them not knowing the ways of spreading intestinal infectious disease.

China↗