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PubMed2003

Care provision for older adults: who will provide?

The aging of the baby boomers comes at a time of a growing nursing workforce shortage: registered nurses, nurse aides, and nursing faculty. Older adults have multiple physical, social, and psychological conditions, making the assessment, planning, and delivery of health care more complex than that of younger adults. Not surprisingly, this age group also utilizes the majority of health services in the country. Thus, most nurses will provide care to older adults in a variety of settings. However, the majority of nurses have little to no background in geriatric nursing. These multiple forces: aging population with complex needs, nursing work force shortage, and lack of geriatric knowledge, along with fewer resources, will have a grave impact on health care in this country in the near future. This article reviews issues related to an aging population, the projected nursing workforce shortage, and the lack of geriatric nursing education; it concludes with suggestions for future health care delivery to the geriatric population in the US

Age Distribution↗
PubMed1997

Baseline and post-treatment assessment of the general health status of head and neck cancer patients compared with United States population norms.

BACKGROUND: It is a common perception that the overall health of patients with head and neck cancer (HNC) is likely to be poor compared with the general population. This project was undertaken to investigate the pre- and post-treatment, global health status of HNC patients in comparison with age-matched, U.S. population norms using a self-administered general health status survey. METHODS: Between July 1, 1993, and May 1, 1996, 180 patients underwent pretreatment and 6 month follow-up evaluation with the standard version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The SF-36 scale scores, means, standard deviations, and 95% confidence intervals were calculated for each SF-36 scale as well as for physical-health-component summary scores (PCS) and mental-health-component summary scores (MCS). Comparisons of these scores were made to U.S. population normative data. Pretreatment and 6-month follow-up SF-36 scores were compared. RESULTS: In the 45-54-year age group, all 8 SF-36 scale scores, the PCS, and MCS scores were significantly worse for the HNC patients in comparison with age-matched norms (p < .05). In the 55-64-year age group, the HNC patients were worse in 5 of the 8 SF-36 scale scores and the MCS score in comparison with age-matched norms (p < .05). In the 65-74-year age group, the HNC patients scored significantly worse in the mental health scale. In the comparison of pretreatment and 6-month follow-up scores, the HNC patients had significant decreases in the physical functioning scale (p = .003) and the PCS score (p = .047). The HNC patients showed significant improvement in the mental health scale (p = .049) and improvement in the bodily-pain scale, which approached significance (p = .053) at 6-month follow-up. The HNC patients showed a marked decrease in general health status with increasing stage of HNC. CONCLUSIONS: This work provides objective support for the perception that many HNC patients are initially seen for treatment with baseline health status functioning significantly below their age-matched contemporaries in the general population. An educated evaluation of global health outcomes following treatment in the HNC patient population must begin with an accurate pretreatment assessment of these parameters. Self-reported health-status assessment (HSA) is a useful means of evaluating global health status in this patient population.

Adult↗
PubMed2003

Double labeling of neurons by retrograde axonal tracing and non-radioactive in situ hybridization in the CNS of adult zebrafish.

A number of genes affecting axonal projections are currently being identified in zebrafish mutant screens. Analyzing the expression of these genes in the adult brain in relation to specific neuronal populations could yield insights into new functional contexts, such as the successful axonal regeneration in adult zebrafish. Here, we provide a relatively simple procedure for non-radioactive in situ hybridization in sections of adult zebrafish brains in combination with retrograde axonal tracing using the fluorescent neuronal tracer rhodamine dextran amine (RDA). A lesion is inflicted on the spinal cord of adult zebrafish and a crystal of RDA is then applied to the lesion site resulting in retrograde labeling of neurons in the brain through their spinal axons. Six to eighteen days later fish are perfusion-fixed, and in situ hybridization is carried out on vibratome-cut floating sections using a protocol simplified from that used for whole-mounted zebrafish embryos. This procedure leads to robust double labeling of axotomized neurons with RDA and an in situ hybridization signal for the growth-associated protein 43 (GAP-43). This method can be used to identify gene expression in specific populations of projection neurons and to detect changes in gene expression in axotomized neurons in the CNS of adult zebrafish.

Animals↗
PubMed1994

[Future changes in the age structure and the problem of pensions in the Austrian case].

Projections of rapid demographic aging in Austria are reviewed up to the year 2050. "After the turn of the century the proportion of the population above age 60 will gradually increase from 20% to at least 30 if not as much as 40 or 50% by 2050. During the same period the population above age 80 will be multiplied by four." It is argued that drastic pension reform is needed to guarantee future pension payments and avoid a large increase in the pension contribution rate. (SUMMARY IN ENG AND FRE)

Adult↗
PubMed1992

[Approaches and methods of fertility estimation in demographic projections].

The author describes methods of fertility estimation within demographic projections. He concludes that both period analysis and cohort follow-up are important to a thorough study of the birth rate of a population. "The second part of the article is dedicated to the procedures used for disaggregating the integral [of] full fertility, and extrapolating the incompleted fertility of a given cohort when formulating birthrate hypotheses." The geographical scope is worldwide. (SUMMARY IN ENG AND RUS)

Birth Rate↗
PubMed1978

The effect of outreach workers' services on the medical care utilization of a disadvantaged population.

An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal. This study was made to determine the effects of these outreach services on (1) the use of or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without services, and utilization data were collected from their medical and administrative records. The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services. Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.

Adolescent↗
PubMed1986

Cholinergic and non-cholinergic projections from the canine pontomesencephalic tegmentum (Ch5 area) to the caudal intralaminar thalamic nuclei.

The distribution and morphology of cholinergic and non-cholinergic neurons projecting to the caudal intralaminar thalamic nuclei from the Ch5 area in the dog were examined using a technique combining horseradish peroxidase (HRP) retrograde labeling with choline acetyltransferase (ChAT) immunocytochemistry. After processing for ChAT, cholinergic neurons were found primarily within the nucleus tegmenti pedunculopontinus (PPN) and the central tegmental tract (ctt). ChAT positive neurons were also located in the nucleus cuneiformis and among the fibers of the lateral lemniscus and medial longitudinal fasciculus. On the basis of immunocytochemical and cytoarchitectonic data, PPN was divided into two distinct cell groups - a compact cell group located dorsolateral to the brachium conjunctivum and a diffuse cell group intermingled among the fibers of the brachium conjunctivum. Tissue processed for WGA-HRP and ChAT following injections of lectin-conjugated horseradish peroxidase into either the centrum medianum (CM) or parafascicular (Pf) nucleus resulted in double labeled cholinergic projection neurons in both PPN and ctt. Injections which involved CM and the caudal part of the central lateral thalamic nucleus (CL) resulted in more retrogradely labeled neurons than did those injections involving Pf. Injections of CM and CL also resulted in more double labeled cells in the dorsolateral compact portion of PPN than did injections confined to Pf. In all cases a small number of cholinergic neurons located in the contralateral PPN were retrogradely labeled as well. A substantial number of retrogradely labeled neurons were not ChAT positive, and in some cases, comprised up to 27% of the total population of projection neurons. Measurements of cell soma areas indicated that cells comprising the general cholinergic population were mostly medium (300-600 micrograms2) or large (greater than 600 micrograms2) in size. The majority of cholinergic projection neurons fell within the medium size category while the noncholinergic projection neurons were significantly smaller than their cholinergic counterparts. The results of this study suggest that in the dog, Ch5 cholinergic neurons which project to the caudal intralaminar thalamic nuclei are medium in size and are located primarily within PPN and ctt. In addition, a parallel projection to the caudal intralaminar nuclei exists which originates from smaller, non-cholinergic neurons in these same regions. Based on the results of this study, it appears that cholinergic projections to intralaminar thalamic nuclei which in turn project to the neostriatum may be one of the pathways over which PPN can affect basal ganglia activity.

Animals↗
PubMed2002

America's adolescents: where have we been, where are we going?

PURPOSE: To determine historical trends and current status of the health of America's youth. METHODS: A thorough literature review was conducted to establish the best sources for adolescent data across a wide range of health-related issues using major national data sources. Data were collected and synthesized to create a comprehensive overview of adolescent health and demographic trends. RESULTS AND CONCLUSIONS: Adolescence is a distinct developmental stage posing unique challenges. Although generally considered a time of health and well-being, traditional health indicators often overlook areas specific to adolescence. Despite encouraging improvements in recent years, this population continues to have high rates of morbidity and mortality owing to violence, injury, and mental health disorders. Also, potentially health-damaging behaviors, such as premature and unprotected sexual behavior and substance use, pose significant threats. Fortunately, adolescence is a time of great behavioral plasticity. Because the vast majority of adolescent health risks are the result of behavioral causes, much of this morbidity and mortality is preventable. The adolescent population is projected to greatly increase over the next 2 decades. However, older age groups are increasing more rapidly, reducing the proportion of adolescents in the overall population. The aging population will likely demand increased access to scarce resources. The public needs to be educated about the need to support programs for youth. If resources are properly allocated, and health professionals trained to deal with adolescents' unique needs, America's youth have the potential to benefit greatly from successful implementation of new knowledge, developing healthy, positive, life-long behaviors.

Adolescent↗
PubMed1998

[Trends in cardiovascular risk factor profiles in East Germany. Three independent population studies as part of the project MONICA East Germany].

OBJECTIVE: To demonstrate trends in cardiovascular risk factors in the population of former East Germany. PATIENTS AND METHODS: As part of the international World Health Organisation's MONICA project ("MONItoring of Trends and Determinants of CArdiovascular Disease"), cross-sectional studies of independent random samples were undertaken, during three periods between 1982 and 1994, among the 24-64 year age groups in the population of East Germany. Those examined were 8470 (1982-1984), 9533 (1987-1989) and 2330 (1991-1994) men and women aged 25-64 years living in 17 regions (until 1989) and three regions (since 1991), respectively. Each person had standardized blood pressure measurements, His/her weight and height were measured, a blood sample was taken, and each was given a standardized interview by trained personnel. RESULTS: The prevalence of hypertension, ca. 30% overall, was relatively high. There was, however, a tendency over time towards a reduced prevalence among the women, from 29% to 25% (P < 0.05). The proportion of effectively treated hypertensives was clearly too low: 12-14% among men, 20-25% among women. There was a slightly downward trend in the frequency of hypercholesterolaemia (> 6.7 mmol/l), but it was statistically significant only for women. The proportion of markedly overweight persons (body mass index > or = 30) was not significantly reduced. The frequency of regular smokers decreased among men from 41% to 35% (P < 0.05), while among women (especially those in the younger age groups) there was a slight increase. CONCLUSIONS: Despite the known importance of risk factors, their prevalence was not significantly changed in East Germany over a period about 10 years. More effort and population-related primary prevention of coronary heart disease will thus be required, particularly in view of the risk factors cigarette smoking and hypertension.

Adult↗
PubMed2004

Relationship between the incidence of type 1 diabetes and enterovirus infections in different European populations: results from the EPIVIR project.

The incidence of type 1 diabetes varies markedly between countries. As enterovirus infections have been linked to type 1 diabetes, we determined whether this variation correlates with the frequency of enterovirus infections in different Caucasian populations in Europe. Enterovirus antibodies were examined in the background population (1-year-old and 10-14-year-old children) in seven countries with either exceptionally high (Finland and Sweden) or low/intermediate incidence of diabetes (Estonia, Germany, Hungary, Lithuania, Russia) using EIA and neutralisation assays. Enterovirus antibodies were less frequent in countries with high diabetes incidence compared to countries with low diabetes incidence (P<0.001). This suggests that enterovirus infections are not particularly common in countries with high diabetes incidence. In contrast, there seems to be an inverse correlation between the incidence of type 1 diabetes and enterovirus infections in the background population, which is in line with the previously proposed polio hypothesis according to which the complications of enterovirus infections become more common in an environment with a decreased rate of infections.

Adolescent↗