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At least 973 records · Page 54Linked to original sources
PubMed2003

Trends in hospitalization after injury: older women are displacing young men.

OBJECTIVE: To evaluate trends in hospitalization after injuries in the USA. DESIGN: National Hospital Discharge Survey data from 1979 to 2000 were evaluated annually by age group, sex, injury severity score (ISS), length of stay, and discharge destination. SETTING AND SUBJECTS: National probability sample of hospitalized patients. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Incidence, duration, outcome, and population based rates of hospital admission after injuries. RESULTS: The number of young males admitted to hospitals after injuries has decreased dramatically; older females are now the group most frequently admitted. Total days in the hospital have decreased in all age groups, but have declined less in the older population than in the younger population; furthermore, most patients aged 65 and over were formerly discharged home, but now most are discharged to long term care facilities. Overall hospitalization rates after injury have decreased in all age groups, but have declined less in the older population; furthermore, male and female hospitalization rates for serious injury (ISS at least 9, excluding isolated hip fracture) are decreasing in younger age groups while increasing in older age groups. CONCLUSIONS: Older patients comprise a growing proportion of injuries requiring hospitalization. Trauma systems must address this change, and preventing injuries in older people is increasingly important.

Adolescent↗
PubMed1998

Geriatric psychiatry subspecialization in Canada: past, present, and future.

OBJECTIVE: To describe the development, future challenges, and directions of geriatric psychiatry in Canada. METHOD: This review and description of geriatric psychiatry was developed in the context of the criteria established by the Royal College of Physicians and Surgeons of Canada for subspecialization applications. Information from key informants, both nationally and internationally, was combined with a review of relevant literature in the field. RESULTS AND CONCLUSIONS: Canada has provided important contributions to the field of geriatric psychiatry in Canada and abroad. The increased needs of older persons with severe mental illness and their families, combined with a significant body of knowledge and therapeutic options, provide an important foundation for further development. Subspecialization in geriatric psychiatry as part of the overall development of psychiatry in Canada is proposed as critical to meeting the challenges of our aging population.

Age Distribution↗
PubMed2000

Race and ethnic variation in the disablement process.

OBJECTIVES: This analysis examines ethnoracial group differences in the transition from health to disability. METHODS: Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability. RESULTS: Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences. DISCUSSION: The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

Activities of Daily Living↗
PubMedDate not supplied

The characteristics of dementia caregiving onset.

This study examined the characteristics of entry into the caregiving role for family and friends of older adults suffering from dementia. Using data from a large community survey of informal caregivers of patients who visited the University of Kentucky's Alzheimer's Disease Research Center (n = 1055), respondents were classified into one of four onset sequences: recognition-diagnosis, care provision, recognition-care, and diagnosis dependent. A multinomial logistic regression identified several characteristics (i.e., caregiver income, time since onset, care recipient gender, care recipient living status, and primary caregiver identification) that were significantly associated with various caregiving onset patterns. The findings describe the complexity of the entry process and its potential association with health-related transitions in the caregiving career.

Aged↗
PubMed2005

Medical concepts related to individual risk are better explained with "plausibility" rather than "probability".

BACKGROUND: The concept of risk has pervaded medical literature in the last decades and has become a familiar topic, and the concept of probability, linked to binary logic approach, is commonly applied in epidemiology and clinical medicine. The application of probability theory to groups of individuals is quite straightforward but can pose communication challenges at individual level. Few articles by the way have tried to focus the concept of "risk" at the individual subject level rather than at population level. DISCUSSION: The author has reviewed the conceptual framework which has led to the use of probability theory in the medical field in a time when the principal causes of death were represented by acute disease often of infective origin. In the present scenario, in which chronic degenerative disease dominate and there are smooth transitions between health and disease the use of fuzzy logic rather than binary logic would be more appropriate. The use of fuzzy logic in which more than two possible truth-value assignments are allowed overcomes the trap of probability theory when dealing with uncertain outcomes, thereby making the meaning of a certain prognostic statement easier to understand by the patient. SUMMARY: At individual subject level the recourse to the term plausibility, related to fuzzy logic, would help the physician to communicate to the patient more efficiently in comparison with the term probability, related to binary logic. This would represent an evident advantage for the transfer of medical evidences to individual subjects.

Chronic Disease↗
PubMed2002

Interactive family learning following a cancer diagnosis.

PURPOSE/OBJECTIVES: To describe the experience of families when a member is diagnosed with cancer. DESIGN: Descriptive, qualitative study. SETTING: Patients' homes. SAMPLE: Eight adults, two to five months postdiagnosis, who were receiving radiotherapy or chemotherapy for stage I or II solid tumors and family members, including seven children between the ages of 13-18. Thirty people interviewed total. METHODS: Patients recruited from an oncology outpatient clinic and gynecologic inpatient unit of a teaching hospital interviewed on one occasion with at least two immediate family members in patients' homes. Semistructured interviews were tape-recorded and analyzed for themes and categories using the techniques of constant comparison. MAIN RESEARCH VARIABLES: Transitions from health to illness. FINDINGS: Families described a learning process in which information was gathered, interpreted, and shared. Families learned together by reviewing the past, gathering and sharing information, and sharing their experiences of living with someone undergoing treatment for cancer. By revealing their own personal perspectives, patients taught their families about their illness experiences and what constituted effective support. CONCLUSIONS: Interactive family learning is a mode of learning and a form of support in which the whole family may participate early in the process of learning to live with cancer. IMPLICATIONS FOR NURSING: Nurses can facilitate patient and family learning by considering the interactive manner in which families acquire information. By acknowledging how past experiences with cancer inform the present, nurses can help families identify beliefs influencing the illness experience. By including families in teaching sessions; facilitating communication between patients, families, physicians, and nurses; and providing take-home learning materials, nurses can facilitate shared information gathering. Nurses should acknowledge the value of learning about illness by experience, accept patients and families as experts, and encourage revelation of patients' and families' perspectives of the illness to enhance feedback on support and coping.

Adolescent↗
PubMed2001

Clinical markers of early disease in persons near onset of Huntington's disease.

OBJECTIVE: There is increasing evidence that neuron loss precedes the phenotypic expression of Huntington's disease (HD). As genes for late-onset neurodegenerative diseases are identified, the need for accurate assessment of phenoconversion (i.e., the transition from health to the disease phenotype) will be important. METHODS: Prospective longitudinal evaluation using the Unified Huntington's Disease Rating Scale (UHDRS) was conducted by Huntington Study Group members from 36 sites. There were 260 persons considered "at risk" for HD who initially did not have manifest disease and had at least one subsequent evaluation. Repeat UHDRS data, obtained an average of 2 years later, showed that 70 persons were given a diagnosis of definite HD based on the quantified neurologic examination. RESULTS: Baseline cognitive performances were consistently worse for the at-risk group who demonstrated conversion to a definitive diagnosis compared with those who did not. Longitudinal change scores showed that the at-risk group who did not demonstrate manifest disease during the follow-up study period demonstrated improvements in all cognitive tests, whereas performances in the at-risk group demonstrating conversion to disease during the study declined across cognitive domains. CONCLUSIONS: Neuropsychological measures show impairment 2 years before the development of more manifest motor disease. Findings suggest that these brief cognitive measures administered over time may capture early striatal neural loss in HD.

Adult↗
PubMed1998

Children's health and the environment: a new agenda for prevention research.

Patterns of illness in American children have changed dramatically in this century. The ancient infectious diseases have largely been controlled. The major diseases confronting children now are chronic and disabling conditions termed the "new pediatric morbidity"--asthma mortality has doubled; leukemia and brain cancer have increased in incidence; neurodevelopmental dysfunction is widespread; hypospadias incidence has doubled. Chemical toxicants in the environment as well as poverty, racism, and inequitable access to medical care are factors known and suspected to contribute to causation of these pediatric diseases. Children are at risk of exposure to over 15,000 high-production-volume synthetic chemicals, nearly all of them developed in the past 50 years. These chemicals are used widely in consumer products and are dispersed in the environment. More than half are untested for toxicity. Children appear uniquely vulnerable to chemical toxicants because of their disproportionately heavy exposures and their inherent biological susceptibility. To prevent disease of environmental origin in America's children, the Children's Environmental Health Network (CEHN) calls for a comprehensive, national, child-centered agenda. This agenda must recognize children's vulnerabilities to environmental toxicants. It must encompass a) a new prevention-oriented research focus; b) a new child-centered paradigm for health risk assessment and policy formulation; and c) a campaign to educate the public, health professionals, and policy makers that environmental disease is caused by preventable exposures and is therefore avoidable. To anchor the agenda, CEHN calls for long-term, stable investment and for creation of a national network of pediatric environmental health research and prevention centers.

Child↗
PubMed1999

International trends in rates of hypospadias and cryptorchidism.

Researchers from seven European nations and the United States have published reports of increasing rates of hypospadias during the 1960s, 1970s, and 1980s. Reports of increasing rates of cryptorchidism have come primarily from England. In recent years, these reports have become one focus of the debate over endocrine disruption. This study examines more recent data from a larger number of countries participating in the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS) to address the questions of whether such increases are worldwide and continuing and whether there are geographic patterns to any observed increases. The ICBDMS headquarters and individual systems provided the data. Systems were categorized into five groups based on gross domestic product in 1984. Hypospadias increases were most marked in two American systems and in Scandinavia and Japan. The increases leveled off in many systems after 1985. Increases were not seen in less affluent nations. Cryptorchidism rates were available for 10 systems. Clear increases in this anomaly were seen in two U.S. systems and in the South American system, but not elsewhere. Since 1985, rates declined in most systems. Numerous artifacts may contribute to or cause upward trends in hypospadias. Possible "real" causes include demographic changes and endocrine disruption, among others.

Cohort Effect↗
PubMed2001

A model of palliative care for the adolescent with cancer.

Adolescents are a distinct group in paediatric and adult cancer and palliative care specialities. The process that is experienced by the patient and his/her family of the transition from health to living with a life-threatening illness and from a life-threatening to a life-limited illness raises specific issues for service provision. The adolescent population presents with a wide variety of physical and emotional maturity that highlights the need for health professionals to be equipped with skills in adolescent care, cancer care and specialist palliative care. Due to the small number of patients who will require such a service in any one health district in the UK this is not usually realistic. This article discusses a model of care that promotes collaborative professional practice in a cancer centre between the paediatric department and adult specialist palliative care team that in turn extends a philosophy of care into cancer units and the community setting.

Adolescent↗
PubMed2000

Too few dentists? Workforce planning 1996-2036.

The development and use of forecasting models can stimulate the debate on workforce planning for dentists by improving the quality of the data available, by providing a framework within which the debate can be conducted and by providing a means whereby the effects of different trends and policy options can be measured in a consistent way. The number of dentists on the Dentists Register aged under 60 years may well fall over the 40 years between 1996-2036, while the proportion of female dentists is likely to grow from under 30% to almost 50%. If the present gender differences in dentists' output persist, the effective 'whole-time equivalent' (WTE) size of the dentist workforce could fall by 15%. While future patterns of disease and the efficacy of future treatments are difficult to predict, the demand for dentistry is very likely to increase, given the forecast ageing of the UK population. The number of people aged 65-74 years could increase by 50% to eight million and those over 75 years by 70% towards seven million. Further, almost of all of this greatly increased older population will have retained some of their own teeth. The edentulous adult population was 37% in 1968 and might fall to less than 5% by 2036. These trends taken together could increase the number of courses of treatment per WTE dentist by as much as 40% over these 40 years. Such modelling can help to reduce the degree of uncertainty in future workforce planning.

Adult↗