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PubMed1995

[Irrationality and risk--a problem analysis].

The way one experiences risks and one's risk behaviour is not centrally the result of rational considerations and decisions. Contradictions and incompatibilities can be proved empirically: (1) General paranoiac hysterical fear of risks, (2) complete repression of health risks, (3) unsureness and inability in dealing with risks, (4) prejudice against risks, (5) admiring risk behaviour, (6) seeking dangerous ways to test one's own limits, (7) readiness for aggression by not subjectively being able to control the risk, (8) naively assessing a risk positively thus intensifying pleasurable sensation, (9) increased preparedness to take risks in groups, (10) increased preparedness to take risk in anonymity, (11) accepting risks as a creative challenge for achievement motivation, (12) loss of innovation when avoiding risks. The awareness and assessment of risk factors is dependent on (1) personality factors (achievement-motivated persons experience risk as a creative challenge; risk behaviour being a variation in stimulus and exploration of one's environment), (2) the social back-ground (booster function), (3) the culture-related assessment of being able to control risks and (4) age (youthful risk behaviour being a way of coping with developmental exercises, e.g. purposely breaking parent's rules, provocatively demonstrating adult behaviour, a means to solve frustrating performance failures, advantages through social acceptance). The way one copes with risk factors is based on subjective estimation of risk; this assessment is made anew for each area of behaviour according to the specific situation. Making a decision and acting upon it is the result of simultaneously assessing the possible psychological benefit-cost factors of taking risks. The extent, to which the threat of risk factors is felt, depends on the importance one attaches to certain needs and benefits of quality of life and, in addition to this, what the subjective probabilities are that one is likely to be befallen by a particular risk; here it is possible that the subjective likelihoods of the risk occurring are maximized and minimized (e.g. hygiene, immunizations risks). The subjective risk hierarchies--they are often contrary to scientific knowledge--are additional evaluation factors.

Adaptation, Psychological↗
PubMedDate not supplied

Medicolegal affairs. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.

ISSUES: Increasing litigation over alleged false negative cervical cytologic (CC) smears threatens the viability of this test for cervical cancer detection. The problem appears to be largely American but is beginning to appear in some other countries. In the vast majority of cases there is either a settlement or jury verdict for the plaintiff based largely on the testimony of expert witnesses. Cases are judged on an individual basis without significant consideration of the general performance of the CC smear in laboratories operating in compliance with a wide array of laboratory regulations and with documented and comprehensive quality control practices in place. It is acknowledged that there are problem laboratories and cytology practitioners. There is an emerging issue of automated preparation and screening devices and issues of informed patient consent. CONSENSUS POSITION: Cytology professionals have done an extraordinary and commendable job of educating the public about the benefits of the CC smear. We have been less successful and conscientious about explaining and defining the limitations of the CC test. There is a need for public and professional education as to the benefits and limitations of the CC smear for cervical cancer detection. The process suggested is to work with women's groups, public health agencies, government agencies, and state and national legislatures and to coordinate professional committees working on liability issues. Contextual information could be included with the CC smear report to indicate that a negative report confers a low probability of developing cervical cancer. It is suggested that appropriate language and a menu of statements be developed. Increased efforts should be directed to physician education with respect to informed consent concerning the benefits and limitations of CC smear testing and the application of new technology to improve smear accuracy. The process should include development of appropriate statements on the use of alternative technology. The profession should develop "process guidelines" for review of CC smears in the context of possible litigation, including standardized methods for blind slide review of smears that reduce or eliminate context and outcome bias. It is suggested that review panels be anonymous, that the process be standardized and that there be limitations on liability for participating organizations. Professional cytopathology and pathology societies should formulate acceptable guidelines for expert witnesses. The standards should be applicable to both defendant and plaintiff experts. All materials to the extent practical, including consultant opinions, should be available for peer review. Professional cytopathology and pathology societies should monitor expert testimony for objectivity and scientific accuracy. ONGOING ISSUES: For the near future, litigation will continue to focus on false negative CC smears on a case-by-case basis. Laboratories and individuals can reduce the risk of malpractice liability by directing their attention to proactive quality control and quality assurance methods. In the final analysis, consumer education about the benefits and limitations of the test is key to limiting malpractice claims. To stem the tide of continued medicolegal challenges to the integrity of cytology practice, the cytology community has now focused its efforts on developing and utilizing standards that convey to patients, attorneys and cytologists the contemporary status of and reasonable expectations for the practice of cytology. Guidelines such as those for uniform reporting terminology and clinical management of cervical abnormalities form the basis of cytology practice standards on which legal standards of practice can be based. Consensus conference reports, clinical management trials and scientifically valid studies of false negative rates that analyze the type, frequency and cause of missed cases represent sounder methods of establishing defensible

Cell Biology↗
PubMed1998

Gender differences in health and risk behaviors among bisexual and homosexual adolescents.

OBJECTIVE: This study explored gender differences in the health and risk behaviors of 394 self-identified bisexual and homosexual adolescents who participated in an anonymous, school-based survey. METHODS: Respondents included 182 girls and 212 boys; girls were significantly younger than boys (p < 0.001), so respondents were further grouped as younger (< or =14 years) and older (> or =15 years) for analysis. Chi-square was used to test for gender differences in health perceptions and risk behaviors. Items included general health perceptions and health care access, body image and disordered eating behaviors, sexual behaviors, alcohol use, and emotional health measures including mood, life satisfaction, and suicidal ideation and attempts. RESULTS: Both younger and older girls were significantly more likely than their male age mates to report a history of sexual abuse, dissatisfaction with weight, a negative body image, more frequent dieting, and an earlier age at onset of sexual intercourse. Both younger and older boys were significantly more likely than girls to have a positive body image, to rate themselves as healthier than peers, to report no regular source of health care, to be sexually experienced, and to drink alcohol more often and in greater quantity; a significantly greater proportion of older boys than older girls reported alcohol use before school (19.0% vs. 3.9%; p < 0.05). No significant gender differences were found for measures of emotional health, including suicidal ideation and attempts; however, nearly 1 of 3 older boys and girls reported at least one suicide attempt. CONCLUSIONS: Gender is a substantive source of variation in health and risk behaviors among bisexual and homosexual adolescents. Health care providers should incorporate gender-specific approaches to health promotion and risk reduction with young people who self-identify as gay, lesbian, or bisexual.

Adolescent↗
PubMed2000

Listening to youth: teen perspectives on pregnancy prevention.

PURPOSE: To ascertain views of public high school students on preventing teen pregnancy. The authors hypothesized that students at varying risk for pregnancy (e.g., abstinent, consistent contraceptors, inconsistent contraceptors) would have differing views which would have implications for future pregnancy prevention programming. METHODS: A 75-question anonymous survey designed for this study was administered in six Boston high schools. The sample consisted of 49% females and 51% males in 10th and 11th grades from diverse racial and ethnic backgrounds. One thousand surveys were received and analyzed using Chi-square tests to assess statistically significant differences in student responses. RESULTS: Sixty-three percent of the students had had sexual intercourse: 72% of males and 54% of females. Of these, 35% were consistent contraceptors and 65% were inconsistent. Students believed that having more information on pregnancy and birth control (52%), education about relationships (33%), parental communication (32%), improved contraceptive access (31%), and education about parenting realities (30%) would prevent teen pregnancy. Abstinent teens were more likely (58%) to say that information on pregnancy and birth control was important (p<.05), whereas consistently contracepting teens were more likely (40%) to identify greater access to birth control (p <.01). Males were more likely than females to prefer their information on contraception from parents (23% vs. 18%) and health education classes (16% vs. 7.5%), whereas females were more likely than males to prefer the health arena (51% vs. 27%) (p<.001). Teens using contraception were also more likely to be having frequent conversations with parents (49%) (p<.001). When asked why they had not used contraception, inconsistent contraceptors were more likely than others to say that they never thought of it (15%) (p<.001). CONCLUSIONS: Teens report that having more information from parents, school, and health arenas can prevent pregnancy. Abstinent, consistent contraceptors, and inconsistent contraceptors have different preferences regarding strategies. This information has important implications for educational content and policy discussions.

Adolescent↗
PubMed2005

[Forgoing life-sustaining measures in patients at the end of life in the German-speaking part of Switzerland: results of a death certificate study].

BACKGROUND AND OBJECTIVE: There have not been any comprehensive data from German-speaking countries on the medical practice of withholding or withdrawing treatment at the end of life. This study from the German-speaking part of Switzerland provides the first in-depth analysis in this field. This study is based on data from this region and is a contribution to a large empirical research project on medical end-of-life decisions in 6 European countries (EURELD). METHODS: Continuous random samples (n = 4991) were taken from all deaths in the German-speaking part of Switzerland that had been reported to the Swiss Federal Office of Statistics between June and October 2001. Doctors who had been attending the deceased person were asked to complete mailed questionnaires, their replies being kept strictly anonymous. RESULTS: The response rate was 67 %. Medications were withheld or withdrawn in 48 % of all treatments forgone: among these, antibiotics accounted for 17 %. Other potentially life-sustaining medical measures forgone included artificial hydration (12 %), surgery (7 %), artificial feeding (6 %), chemotherapy (6 %), diagnostic tests (4 %), hospital admissions (3 %), renal dialysis (2 %), blood product infusions (2 %), intubation (2 %), ventilation (2 %), resuscitation (2 %), and radiotherapy (1 %). 43 % of all treatments were forgone in patients who died in hospital, 42 % in nursing homes, and 15 % at home. In almost three-quarters (73 %) of the treatments forgone, a primary-care doctor had ordered the treatment to be withheld or withdrawn. On average, forgoing treatment led to a life-shortening effect of more than one month in 8 % of all cases. The proportion was higher for renal dialysis (25 %), blood products infusion (18 %), and diagnostic tests (16 %). CONCLUSIONS: Forgoing life-sustaining medical treatment comprises a wide range of decisions taken in many different clinical settings. In most cases the likely lifespan is only slightly shortened.

Adolescent↗
PubMed2005

Influenza vaccine: immunization rates, knowledge, and attitudes of resident physicians in an urban teaching hospital.

BACKGROUND: Because resident physicians (RPs) frequently have direct patient contact, those who are unimmunized against influenza potentially subject patients to unnecessary risk of infection. OBJECTIVE: To determine the rates of, knowledge regarding, and attitudes toward influenza immunization among RPs. We hypothesized that rates of and knowledge about influenza immunization did not differ between primary care (PC) and non-PC RPs. METHODS: A self-administered, anonymous questionnaire distributed to a convenience sample of 300 RPs (150 PC and 150 non-PC). The questionnaire requested influenza immunization status in the 2003-2004 and previous seasons and factors influencing respondents' decisions whether to be immunized. It included a 20-item test of knowledge about influenza immunization. RESULTS: Two hundred five (68.3%) of 300 distributed questionnaires (196 that were evaluable) were returned. Response rates of PC and non-PC RPs did not differ (P = .79). The overall immunization rate of RPs in 2003-2004 was 38.3% and rates did not differ between PC (38.9%) and non-PC (37.6%) RPs. RPs most often cited "self-protection" as a reason for electing (93.3%) and "lack of time" for declining (47.1%) influenza immunization. Their ability to correctly answer questions about influenza immunization varied; their mean knowledge score was 13.7 (perfect = 20). PC and non-PC trainees did not differ by knowledge score (P = .48). However, RPs "ever vaccinated" had a higher knowledge score than those "never vaccinated" (P = .01). CONCLUSION: RPs have low immunization rates and significant gaps in knowledge regarding influenza immunization. These problems should be addressed during their training by education on the importance, effectiveness, and safety of influenza vaccine for them and their patients.

Adult↗
PubMed1997

'TransMem': a neural network implemented in Excel spreadsheets for predicting transmembrane domains of proteins.

MOTIVATION: Genomic sequences from different organisms, even prokaryotic, have plenty of orphan ORFs, making necessary methods for the prediction of protein structure and function. The prediction of the presence of hydrophobic transmembrane (HTM) stretches is a valuable clue for this. RESULTS: The program. TransMem, based on a neural network and running on personal computers (either Apple Macintosh or PC, using Excel worksheets), for the prediction and distribution of amino acid residues in transmembrane segments of integral membrane proteins is reported. The percentage of residue predictive accuracy obtained for the set of proteins tested is 93%, ranging from 99.9% for the best to 71.7% for the worst prediction. The segment-based accuracy is 93.6%; 63.6% of the protein set match any of the predicted and observed segment locations. AVAILABILITY: TransMem is available upon request or by anonymous up: IP address: luz.uab.es, directory/pub/ TransMem. It is also placed on the EMBL file server (ftp:/(/)ftp.ebi.ac.uk/pub/software/mac/TransMem ).

Animals↗
PubMed1991

Prevalence of infection with human immunodeficiency virus in elective surgery patients.

An anonymous survey of elective surgery patients was performed to assess prevalence of antibody to human immunodeficiency virus (HIV) in a large urban hospital. Of 4087 patients evaluated, 18 (0.4%) were found to be infected with HIV as confirmed by a positive Western blot antibody test. Assessment of risk factors demonstrated that patients with a history of a blood transfusion did not differ in demographics or rate of infection from the population as a whole. Of the 18 HIV infected patients, 13 gave an admission history of one or more risk factors, including 10 with a history of a prior positive test. Only five, or 0.12% of the patients, provided no history of a risk factor or a history of transfusion only. The authors conclude that the prevalence of HIV infection among elective surgery patients is low, and that there would not be any substantial benefit from screening such patients for antibody against HIV.

AIDS Serodiagnosis↗
PubMed2006

Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder.

BACKGROUND AND METHODS: We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years. RESULTS: For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year. CONCLUSIONS: Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.

Adult↗
PubMed2005

HIV risk and protection among gay male couples: the role of gay community integration.

This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.

Acculturation↗
PubMed2004

Training improves medical student performance in image interpretation.

The aim of this study was to objectively quantify the effects of radiological teaching on student performance in interpreting radiological images, and to establish whether training location affects performance. 114 clinical students were asked to anonymously interpret radiological cases before and after 26 weeks clinical training. Improvements were assessed by comparing performance on the median question in each assessment using the Kruskal-Wallis analysis. Variations according to different placements were assessed by the Mann-Whitney U-test. There was a highly significant (p<0.001) improvement in the performance of the group with training. The proportion of correct answers to the median question improved from 8% to 43%. Differences between training placements were non-significant. Our study suggests that radiology teaching significantly improves student performance. Future work should look to define the contribution of "clinical exposure" towards this improvement, as well as the various teaching methods employed.

Clinical Competence↗
PubMed2001

Patient expectations and costs of immediate reporting of screening mammography: talk isn't cheap.

OBJECTIVE: Our purpose was to determine whether patients prefer immediate or delayed results of screening mammography and to determine the cost of immediate reporting at our institution. MATERIALS AND METHODS: A survey was anonymously and randomly distributed to 129 women who were 35-70 years old during a visit to their primary care physician, asking the women's preference for receiving mammography results by one of two systems: by letter with a return visit for any additional tests; or by speaking at once with the radiologist, with the option of additional tests being performed during the same visit. Patients' willingness to pay for the latter service was also determined. A cost identification model was constructed using commercially available software. We considered the impact on radiologists' and technologists' time and the need for additional equipment and space, and we analyzed the effect on the cost of immediate reporting. RESULTS: One hundred twenty (93%) surveys were completed. Eighty women (67%) preferred immediate reporting, and 62 (78%) of these 80 patients would wait 30-60 min. The additional cost of immediate reporting is $28.22 per patient. Only 11% of patients were willing to pay this additional cost. When new equipment and space were not required, the cost would increase by $4.38. This cost was most influenced by the time required to give patients normal results. CONCLUSION: Most surveyed patients preferred speaking with a radiologist immediately but were unwilling to pay additional fees. Radiologists, hospital administrators, and health care planners must be aware of the costs of immediate reporting and must factor these costs into any change in hospital or national policy.

Adult↗
PubMed2006

Public opinion survey after capsule endoscopy: patient s point of view on its utility.

AIM: When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required. MATERIAL AND METHODS: From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general. RESULTS: Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device. CONCLUSIONS: After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.

Adult↗
PubMed1986

HLA typing used with cultured amniotic and chorionic villus cells for early prenatal diagnosis or parentage testing without one parent's availability.

Like fetal fibroblasts and amniotic fluid cells, cultured chorionic villus cells can also be HLA typed with selected typing sera after preincubation with gamma interferon to promote better antigen expression. A modified procedure now in use would also allow any of these cell types to be tested for the presence or absence of all known HLA A,B,C, and DR antigens with standard preplated typing trays. This procedure was used to confirm that an on-going pregnancy had resulted from the successful in vitro fertilization and implantation of an anonymous donor's ovum and could also be of major use in rape or artificial insemination cases when the identity of the possible father(s) is not known.

Amnion↗
PubMed2003

Ratings of contracting infectious diseases and of the risk of sexual HIV transmission by health care students from Germany, Lithuania, and Namibia.

In Germany, Lithuania, and Namibia different types of the HIV epidemic are present. HIV testing of health care students and their ratings of the risk of sexually acquired HIV infections and factors influencing the risk of contracting infectious diseases were analyzed. 182 German medical and dental students, 176 Lithuanian medical students, and 135 Namibian student nurses participated by completing anonymous questionnaires. The Namibian student nurses rated sexual HIV transmission risks higher than the Lithuanian and German medical students did. In general, the Lithuanian medical students rated risks of HIV transmission lowest, compared to the students in the other two samples. Risk behavior and environmental factors were most emphasized by the three student samples as having an influence on the risk of contracting infectious diseases. Thus, national prevalence of HIV influences ratings of sexual HIV transmission risks, while rating of factors influencing the risk of contracting infectious diseases are similar.

Adolescent↗
PubMed2002

Naltrexone in alcohol dependence: a randomised controlled trial of effectiveness in a standard clinical setting.

OBJECTIVES: To determine whether naltrexone is beneficial in the treatment of alcohol dependence in the absence of obligatory psychosocial intervention. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial. SETTING: Hospital-based drug and alcohol clinics, 18 March 1998 - 22 October 1999. PATIENTS: 107 patients (mean age, 45 years) fulfilling Diagnostic and statistical manual of mental disorders (4th edition) criteria for alcohol dependence. INTERVENTIONS: Patients with alcohol dependence were randomly allocated to naltrexone (50 mg/day) or placebo for 12 weeks. They were medically assessed, reviewed and advised by one physician, and encouraged to strive for abstinence and attend counselling and/or Alcoholics Anonymous, but this was not obligatory. MAIN OUTCOME MEASURES: Relapse rate; time to first relapse; side effects. RESULTS: On an intention-to-treat basis, the Kaplan-Meier survival curve showed a clear advantage in relapse rates for naltrexone over placebo (log-rank test, chi(2)(1) = 4.15; P = 0.042). This treatment effect was most marked in the first 6 weeks of the trial. The median time to relapse was 90 days for naltrexone, compared with 42 days for placebo. In absolute numbers, 19 of 56 patients (33.9%) taking naltrexone relapsed, compared with 27 of 51 patients (52.9%) taking placebo (P = 0.047). Naltrexone was well tolerated. CONCLUSIONS: Unlike previous studies, we have shown that naltrexone with adjunctive medical advice is effective in the treatment of alcohol dependence irrespective of whether it is accompanied by psychosocial interventions.

Adolescent↗
PubMed2002

The prevalence of pathological gambling in Romanian teenagers.

BACKGROUND: The liberalization of teenagers' way of life strikingly increased in Romania after 1989; this includes gambling. The goal of our study is to analyze the different aspects of gambling in some teenager communities in Romania. METHODS: The study included 500 school-teenagers from 3 different Romanian districts (Cluj, Salaj and Bacau). Of these 217 (43.40%) were males and 283 (56.60%) females. Median age was 16 years old (range 14-19). A structural questionnaire was applied to the teenagers consisting in "The 20 questions of the American Anonymous Gambling Association". Other 20 questions about their age, gender, family, income, school, toxic abuse, gambling preferences, the frequency and the amount of money they use in gambling were also proposed. RESULTS: The results of the study were as it follows: 34 (6.8%) of the tested teenagers were pathological gamblers, 28 (82.36%) males and 6 (17.64%) females, with a ratio F:M of 1:4.6. The average age of starting gambling was 13.25 1.51 years old. The majority (82.35%) prefers group gambling and only 17.64% prefer individual gambling. Of these, 47.5% of them gamble very often (almost every day) and 38.2% gamble often (once a week). The most frequent gambling was: pool (55.88%), poker (35.29%), bingo (32.35%), and basketball on a bet (5.88%), black-jack, roulette and craps (2.94% each). Gambling was the reason for school absenteeism and modest results at school in 64.70% and 52.94% of all the teenagers respectively. CONCLUSIONS: The results of the study revealed very concerning aspects of the increased incidence of gambling among Romanian teenagers, compared to the UK (6% of them are gambling).

Adolescent↗
PubMed2005

Comparing the health services utilization of long-term-care residents, home-care recipients, and the well elderly.

Research has typically supported the concern that health services utilization increases with aging. Yet most health services utilization studies have focused on the use of 1 as opposed to all health services, the use of health services over 1 year as opposed to a longer period, and the use of health services during the 1970s or 1980s. Current, comprehensive utilization studies are needed in order to better inform health policy and health services decision-making. This study was designed to compare the health services utilization of 3 groups of seniors: those residing in long-term-care (LTC) facilities, those receiving home care, and those neither institutionalized nor receiving home care. Individual-anonymous and population-based inpatient hospital data, ambulatory care (day surgery, outpatient clinic, and emergency room) data, and physician services data collected by the health ministry of the Canadian province of Alberta over a 2-year period were analyzed using descriptive and comparative statistical tests available in the SPSS computer program. With the exception of physician and LTC services, LTC residents were the least likely to use health services. Furthermore, and despite concerns that LTC residents may be stigmatized or rationed with regard to access to tertiary care, the data indicate that LTC residents are not disadvantaged in terms of type or scope of hospital services. These and other findings suggest an appreciation for LTC in managing both the health and the care needs of the oldest seniors. The findings also raise concerns about the adequacy of formal home care and of the health care received by the well elderly.

Activities of Daily Living↗