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PubMed2005

Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.

BACKGROUND: Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults. OBJECTIVE: The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use. METHODS: This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected. RESULTS: Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used > or = 1 Beers drug. Compared with individuals who used no Beers drugs, those who used > or = 1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90-0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11-1.97), used more medications (OR, 1.07; 95% CI, 1.01-1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05-2.66), hypertension (OR, 1.58; 95% CI, 1.07-2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09-2.29), and back problems (OR, 1.72; 95% CI, 1.19-2.47). CONCLUSION: As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.

Adult↗
PubMed1995

Long-term oxygen therapy with concentrators and liquid oxygen.

The National Institute for Insurance of Disease and Disablement (RIZIV/INAMI) in Belgium reimburses the costs of long term oxygen therapy (LTOT) by concentrators since 1984 and by liquid oxygen since 1988 for specific categories of patients supervised by approved medical centers. Since then we prescribed these therapies for 83 patients (49 with COPD, 12 with lung fibrosis, 22 with miscellaneous diseases). Since 1984 40 concentrators were prescribed of which 34 have been installed and 11 were still operating in July 1992 at the end of the study: 12 patients died, 2 stopped LTOT and 10 switched to liquid oxygen. Since 1989 43 patients started with liquid oxygen systems, together with the 10 patients who switched from concentrators to liquid oxygen, thus 53 liquid oxygen systems had been described and 46 were still in use in July 1992: 5 patients died and 2 stopped LTOT. Patient characteristics at entry were: age 62 +/- 11 years (mean +/- 1SD), PaO2 50 +/- 6 mmHg, PaCO2 47 +/- 10 mmHg, polycythemia in 12%, clinical right heart failure in 47% and ECG signs of right ventricle hypertrophy in 70%. Two year survival was 75% for the whole group and 60% for the COPD patients. In patients with COPD improvement of PaO2 (on air) after 1 year of LTOT (+ 10 +/- 8 mmHg in survivors versus 0 +/- 6 mmHg in non-survivors) was significantly related to survival (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner violence.

OBJECTIVE: Intimate partner violence (IPV) poses major health threats to women, including increased risk for several chronic health conditions. The impact of IPV on use of preventive health services is not well understood. Although several studies indicate that female victims of IPV have higher rates of alcohol abuse, this has not been replicated in population-based studies. The association of IPV with smoking has not been a major research focus. The purpose of this study was to examine the association between physical and psychological IPV in the past 12 months and preventive healthcare use, smoking, and alcohol use among women. METHODS: Data on 1643 women aged 18-54 from the 1999 Rhode Island Behavioral Risk Factor Surveillance System were analyzed. Logistic regression, controlling for age, race, marital status, education, insurance status, and functional disability, was used to model the associations of IPV with (1) checkups, (2) clinical breast examinations (CBEs), (3) Pap smear screening, (4) cigarette smoking, and (5) high-risk alcohol use. RESULTS: Prevalence of physical IPV was 4.1%. The prevalence of psychological IPV, in the absence of physical IPV was 4.5%. Physical IPV was associated with receiving regular Pap smears odds ratio ([OR] = 2.39, 95% confidence interval [CI] 1.01-5.70), current smoking (OR = 2.07, 95% CI 1.03-4.18), and high-risk alcohol use (OR = 4.85, 95% CI 2.02-11.60). Psychological IPV was associated with high-risk alcohol use (OR = 3.22, 95% CI 1.46-7.09). CONCLUSIONS: Women experiencing IPV regularly access preventive healthcare, providing healthcare providers with opportunities to assess and counsel women for IPV in addition to smoking and high-risk alcohol use.

Adult↗
PubMed2001

Compensation and chronic pain.

BACKGROUND: The literature contains many different viewpoints on the impact of compensation on recovery from chronic pain. OBJECTIVE: What is the role of compensation in chronic pain and/or chronic pain disability? METHODOLOGY: The literature search identified 11 observational studies to provide evidence about this question. RESULTS: There is a paucity of high-quality data on the subject of the impact of compensation on chronic pain. This subject was reviewed under the headings of (1) injury claim rate and duration; (2) recovery; and (3) rehabilitation treatment programs. The studies were of subjects with musculoskeletal pain, mainly low back pain. CONCLUSIONS: Filing a compensation claim for costs, retaining a lawyer, or higher pain intensities were limited predictors of longer claims (level 3). As the ratio of compensation to preinjury wage increases, there is moderate evidence (level 2) that the duration of the claim increases and that disability is more likely. Compensation status, particularly combined with higher pain intensities, is associated with poorer prognosis after rehabilitation treatment programs (level 3).

Chronic Disease↗
PubMed1988

Preparing the company physician to testify at legal proceedings.

Company physicians are frequently required to testify as to their findings and opinions in cases where employees' health jeopardizes their work status. The company physician may face conflicting ethical obligations in weighing the physician-patient relationship against the needs of the employer. If the employee seeks outside health care assistance, the company physician may have to testify against other health care professionals. The three most common forums in which the company physician may be asked to submit medical reports and/or testify are arbitration hearings, workers' claims for Social Security disability, and workers' compensation insurance benefits. Company physicians should be aware of the nature of each type of proceeding and they should be prepared to render persuasive expert testimony.

Ethics, Medical↗
PubMed1981

Elusive allowances.

Explore the source record for details and available documents.

Attitude to Health↗
PubMed2006

Reported occupational respiratory diseases in Catalonia.

OBJECTIVES: A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. METHODS: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician's opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. RESULTS: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. CONCLUSIONS: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register.

Adult↗
PubMed1982

Social Security and SSI benefits for the mentally disabled.

More than a half million mentally ill or mentally retarded individuals received Social Security or Supplemental Security Income disability payments in 1980. To become eligible for these payments, claimants must go through a multilayered adjudication process to establish the severity of their condition. Yet because of their symptoms, many mentally disabled individuals are unable to fend for themselves properly through this process. The author describes the different levels in the adjudication process, outlines the problems the mentally disabled encounter in applying for benefits, and proposes an advocacy program for mental health professionals to follow in assisting claimants in applying for benefits. Such an advocacy program should be given high priority in the operational budgets of all publicly funded mental health and mental retardation facilities, the author asserts.

Disability Evaluation↗