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PubMed1984

Age-based transition periods and the outcome of mental health treatment.

Do people ever get too old to change? Studies of the influence of the age of adult patients on the outcome of mental health treatment have led to inconsistent results. Design characteristics of such studies have limited our understanding of the relationship between age and outcome. Over 300 male veterans undergoing brief inpatient psychiatric treatment were categorized according to their age-based, adult developmental period (Levinson, Darrow, Klein, Levinson, & McKee, 1978). Improvement during treatment was found to be significantly related to the patient's developmental stage (r = .25, p less than .01). These results wee cross-validated and replicated using three different techniques for measuring improvement. Patients treated during transition periods, whether young or old, improved most. These results were not limited to wartime veterans. Apparently, adult males are more responsive to mental health treatment during transition periods than at other times.

Age Factors↗
PubMed2002

The transition into adulthood for children and youth with special health care needs.

With advances in medical care, children with chronic medical conditions are living longer lives. They, their families, and their health care professionals are faced with new challenges: transition from pediatric care into adult medical care and meeting the vocational, educational, and other social needs to make this transition of children and youth with special health care needs successful. This article identifies problems and proposed solutions to start to make this transition more successful, including the results of working meetings of representatives from Texas, Oklahoma, New Mexico, and Arkansas.

Adolescent↗
PubMed2006

Conversion from cognitive health to mild cognitive impairment and Alzheimer's disease: prediction by plasma amyloid beta 42, medial temporal lobe atrophy and homocysteine.

The changes of plasma amyloid beta (Abeta42) protein, homocysteine and medial temporal lobe atrophy (MTA) were studied by the transition from cognitive health to mild cognitive impairment (MCI) and to Alzheimer's disease (AD) in a prospective cohort of individuals aged 75 years. MTA but not plasma Abeta42 measured at baseline predicted which persons remained cognitively healthy (CH) and who developed AD 2.5 years later. The increase of plasma Abeta42 over time significantly distinguished between persons who remained CH on the one hand and MCI converters and AD converters out of cognitive health on the other (CH-to-MCI and CH-to-AD converters). Although both groups showed similar increase of Abeta42 levels, CH-to-AD converters had a higher increase of homocysteine compared to CH-to-MCI converters or to persons remaining CH. In comparison to all cognitive subgroups, the AD converters from MCI at baseline showed the smallest increase of Abeta42 levels and rather no increase of homocysteine. In logistic regression analysis, the increase of plasma Abeta42 but not change of MTA significantly predicted the conversion from CH to MCI, and changes of MTA and homocysteine but not of plasma Abeta42 predicted the conversion from CH to AD. The increase of plasma Abeta42 correctly allocated CH-to-MCI and CH-to-AD converters with low (63%) specificity (for both) and low (60%) sensitivity (54% for AD group). These results indicate that (1) plasma Abeta42 alone is not suitable as a biomarker for AD, (2) in the course of cognitive deterioration of the AD-type the increase of plasma Abeta42 seems to be an initial event, (3) similar to cerebrospinal fluid, changes of plasma Abeta42 may reflect the transition from cognitive health to AD, and (4) whether persons with MCI develop AD may depend on an accumulation of further toxic metabolites such as homocysteine.

Aged↗
PubMed1996

Policy relevance of the health expectancy indicator; an inventory in European Union countries.

Due to epidemiological transitions in population health both an increase in life expectancy and in chronic morbidity and disability have been observed in many countries. Consequently the tension between 'living longer' on the one hand and the 'quality of life' on the other have become a central health policy problem. The introduction of the indicator 'health expectancy' (HE), a measurement that combines mortality data with morbidity and disability data, was a logical reaction to these changes and to the growing need of a present-day yardstick to estimate this problem. The HE indicator is still under development, a process being furthered by the international network of researchers, REVES. A European project, called Euro-REVES, aims to promote and harmonize future HE calculations in Europe. To begin this project and to gain more insight into the indicator's policy relevance, an inventory has been carried out among policy makers, National Statistical Institutes and researchers in countries of the European Union (EU). This paper presents the results of the inventory, attempts to place these within a provisional classification system of HE types, and discusses the consequences of the findings for further conceptual harmonization and development of the indicator. Already 11 of the 15 ER member states have HE results available. The actual use of such results for policy making is increasing. Notwithstanding a great diversity in sources and questions used for the calculations, there seems to be enough simularity to give the harmonization effort a good perspective.

Chronic Disease↗
PubMedDate not supplied

The future of the public's health: vision, values, and strategies.

The expansive vision of modern public health, "healthy people in healthy communities," is politically charged. This paper offers a justification for this broad vision and offers concrete proposals. By pointing to the poor condition of public health agencies; urging a transition to an intersectoral public health system; promoting the adoption of bold changes in U.S. physical, social, and economic conditions; and endorsing a values shift to a commitment to collective interest in healthier communities, we hope to take a dramatic step toward achieving these aspirations for "healthy people in healthy communities."

Health Policy↗
PubMed2002

Improving return to work outcomes. Formalizing the process.

Potential for decreasing absences, saving disability costs, and improving productivity are important motivators for convincing employers to formalize their RTW program. The first step in formalizing a RTW program is developing a written corporate RTW policy statement. Another essential step is reviewing jobs and completing job analyses quantifying the physical and environmental requirements of the position. These valuable job analysis tools can be used to assist employers and health care providers with proactive transitional work options. Occupational health nurses must focus their skills on assessing, monitoring, and evaluating improvements in RTW outcomes, as well as translating their interventions into measurable value added services and cost savings.

Accidents, Occupational↗
PubMed2004

Aiming for more than a base HIT.

To position themselves for optimal use of health information technology through goals such as electronic health records and the eventual transition to a national health information infrastructure, providers need to make better decisions regarding the use of their existing systems.

Decision Making, Organizational↗
PubMed1986

Mortality transition in Korea: its implications for health policy and education.

This paper discusses the progress and prospects for mortality reduction in Korea, drawing upon the scanty data available in the literature. Data suggest that recent mortality improvement in Korea is slowing; that male mortality patterns at older ages are deviating from model life tables: that infant and child mortality is relatively high; and that transitional changes in the cause-of-death structure of infants and children are lagging behind their elders. Implications of these trends form a principal basis for concern about health policy issues in Korea. Any continuing progress in mortality would require major effort in several areas: accurate and adequate assessment of disease patterns and health behavior; reexamination of current health care strategies and public health measures; and analyses of social and economic development policies relevant to health conditions.

Adolescent↗
PubMed1991

The impact of the dream on mental health functioning in the male midlife transition.

In the area of adult development, Levinson's notion of the personal Dream is important in understanding the male midlife transition. Levinson suggests that during this period in the life cycle the status of the Dream becomes a prominent issue, as men become increasingly aware of the limits of their achievements. Sixty-four midlife men filled out questionnaires examining whether they had a Dream, and whether they experienced or anticipated experiencing success or failure of that Dream. The Beck Depression Inventory, the IPAT Anxiety Scale, and the Purpose-In-Life Test were included to assess the mental health status of the respondents. The results support the conclusion that whether a man has a Dream, and the degree to which he experiences success in achieving it are significantly related to his mental health status (i.e., depression, anxiety, and purpose-in-life) during the midlife transition.

Achievement↗
PubMed1997

Health expectancy and the problem of substitute morbidity.

During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between 'living longer' on the one hand and health-related 'quality of life' on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so-called epidemiological transition in population health. The first one concerns the question of how--given the impressive changes--population health can be measured in an adequate and policy relevant present-day fashion. The second one is the so-called phenomenon of 'substitute morbidity and mortality': more and more acute fatal diseases are replaced by non-fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease-specific expectations of interventions and asks for a shift to a 'total population health' perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the 'dynamic equilibrium' theory. In absolute numbers, however, the burden of disease will continue to increase with further ageing of the population.

Adult↗
PubMed2005

How does self-assessed health change with age? A study of older adults in Japan.

OBJECTIVE: This research examines how the trajectories of self-rated health evolve among elderly Japanese individuals and how socioeconomic status (SES), social relations, and baseline health differentiate these trajectories. METHODS: Data came from a five-wave panel study of a national sample of 2,200 Japanese old adults between 1987 and 1999. Hierarchical linear models and cluster analysis were employed to depict major patterns of temporal changes in self-rated health. RESULT: Overall perceived health becomes worse, but only slightly, between ages 60 and 85, whereas it appears to improve a little bit after age 85. Underlying the observed age norm are four subtrajectories including constant good health, early onset of perceived health decline, late onset of perceived health decline, and a course of recovery from poor self-assessed health. DISCUSSION: Diverse subjective health trajectories exist in old age, extending well into the 90s. Prior observations of the effects of SES, social relations, and baseline health on health states and transitions can now be extended to trajectories of subjective health. Our analysis of Japanese data provides important benchmarks for comparisons with observations made in other developed nations.

Adaptation, Psychological↗
PubMed2006

Victimization and health among indigent young women in the transition to adulthood: a portrait of need.

PURPOSE: To understand victimization by physical and sexual violence and its association with physical and behavioral health in a probability sample of sheltered homeless and low-income-housed young women in the transition to adulthood (ages 18 through 25). METHODS: Participants were 224 women ages 18 through 25 who were selected by means of a stratified random sample from 51 temporary shelter facilities (N = 94) and 66 Section 8 private project-based Housing and Urban Development (HUD)-subsidized apartment buildings (N = 130) in Los Angeles County, California. Women completed structured interviews. RESULTS: Forty-one percent of the sample had been physically or sexually victimized as children and 51% had been victimized since turning 18. Young women who experienced victimization were significantly (p < .05) more likely than non-victimized women to have a sexually-transmitted disease (STD) other than HIV/AIDS or Hepatitis B or C, vaginal discharge or bleeding and pelvic pain in the past 6 months, and past-12 month screening diagnoses of drug abuse/dependence and depression. Victimized women were also significantly more likely to use alcohol to intoxication and drugs, including crack and amphetamines, during the past 6 months, and to have experienced psychological distress and poor self-esteem. CONCLUSIONS: This study highlights striking rates of victimization and its association with physical and behavioral health problems among indigent young women during the period of emerging adulthood. This portrait of need communicates an urgency to develop multifaceted programs for such women to help them successfully navigate the transition to adulthood and realize their full potential as adults.

Adolescent↗
PubMed2005

Telepharmacy in a health maintenance organization.

PURPOSE: A telepharmacy service in a health maintenance organization is described. SUMMARY: Kaiser Permanente Colorado Region's clinical pharmacy call center (CPCC) was established in 1996 after an audit showed that the third most common type of call to the regional call center involved questions about drug therapy. The service was developed through collaboration among the pharmacy department, the medical group, and the health plan to care for patients with medication-related questions. CPCC pharmacists work closely with the physicians, nurses, and service associates of the regional call center; primary care physicians; and other pharmacy department members. The CPCC team answers approximately 1200 telephone calls daily, including calls from new members regarding their transition into the health plan, calls about medications for patients recently discharged from outside hospitals, questions about medication-related news releases, and general drug therapy questions. CPCC pharmacists collaborate with physicians to care for patients with allergic rhinitis and to complete projects that improve the quality and cost-effectiveness of drug therapy regimens. Many of CPCC's interactions are entered into an electronic medical record. CPCC has helped over 40,000 new members with their transition into the health plan since January 2000, and significant cost savings have resulted. CONCLUSION: CPCC has used telephonic, electronic, and other means of communication in an effort to reduce costs and improve the quality of care.

Continuity of Patient Care↗
PubMed2005

The menopausal transition was associated in a prospective study with decreased health functioning in women who report menopausal symptoms.

OBJECTIVE: To examine change in health functioning as women progress through the menopausal transition. STUDY DESIGN AND SETTING: Prospective study of 2,489 women followed through four phases of the Whitehall II study. Health functioning was assessed with the eight subscales of the SF-36. RESULTS: Compared with peri- and postmenopausal women who did not experience menopausal symptoms, women who reported vasomotor symptoms or menopausal depression experienced large and significant declines on most scales of the SF-36. Women who reported the greatest symptom severity experienced the largest declines in functioning. For example, decline in physical functioning for perimenopausal women experiencing severe vasomotor symptoms was 3.3 (standard error SE=1.1) greater than those who experienced no vasomotor symptoms. Decline in role limitation-emotional for perimenopausal women experiencing severe menopause-associated depression was 18.4 (SE=2.3), compared with those who did not experience these symptoms. Vasomotor symptom reporting was predicted by low socioeconomic position, high body mass index, and limiting long-term illness at baseline. Menopause-associated depression was additionally predicted by smoking and depression. CONCLUSION: The menopausal transition is associated with decreased health functioning in women who report menopausal symptoms. Menopausal symptoms are strongly related to all aspects of health functioning assessed by the SF-36. Socioeconomic and behavioral risk factors for menopausal symptoms and associated declines in health functioning have been identified.

Adult↗
PubMed2003

Disability-free life expectancy of elderly people in a population undergoing demographic and epidemiologic transition.

BACKGROUND: the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. OBJECTIVES: to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. DESIGN: a cross-sectional multi-stage random sample survey and routine life tables for Thailand. SETTING: national population of Thailand. SUBJECTS: 4,048 elderly subjects aged 60+ years. RESULTS: prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. CONCLUSION: long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.

Age Factors↗
PubMed2003

Acute public health consequences associated with hazardous substances released during transit, 1993-2000.

Massive quantities of hazardous substances are transported each day throughout the United States. While most arrive safely at their destination, uncontrolled releases of substances in transit do occur and have the potential of causing acute public health consequences for those individuals at or near the release. Data from 16 state health departments participating in the Agency for Toxic Substances and Disease Registry's (ATSDR) Hazardous Substances Emergency Events Surveillance (HSEES) system were analyzed to determine the public health consequences that occurred from actual releases in transit. Of the 9392 transportation events analyzed, 9.1% resulted in 2008 victims, including 115 deaths. The population groups injured most often were employees and the general public. The most common injury sustained was respiratory irritation. Evacuations were ordered in 5.5% of events effecting at least 63,686 people. Human error and equipment failure were the most common factors leading to events. These findings underscore the importance of job safety training, community planning, and effective emergency response to prevent adverse public health consequences from occurring or lessen their effect on the public.

Disasters↗