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PubMedDate not supplied

Determination of positional skin-surface pressures in premature infants.

PURPOSE: To describe the skin-surface pressure distributions and points of maximal pressure that are generated by healthy premature infants in the supine, prone, and right side-lying positions. DESIGN: A descriptive, repeated-measures design. SAMPLE: Four medically stable premature infants of 34 weeks postconceptional age. The mean weight was 2,180 gm, and the mean age was 24.5 days. RESULTS: Similar regions of increased skin-surface pressures were identified for the four infants. Within areas of peak pressure, some sensor cells reached 28-32 millimeters of mercury, which is considered to be the critical compressive pressure for obstruction of nutritive flow to the underlying body tissues. These descriptive results may be a starting point for development of research studies to determine positioning strategies to optimize the skin integrity of premature infants while minimizing unnecessary handling.

Clinical Nursing Research↗
PubMedDate not supplied

COMFORT scale: a reliable and valid method to measure the amount of stress of ventilated preterm infants.

OBJECTIVE: Assessment of clinimetric properties and diagnostic quality of a stress measurement scale (COMFORT scale). DESIGN: Sample of an open population. SETTING: Neonatology department (Neonatal Intensive Care Unit), Academic Medical Centre/Emma Children's Hospital, Amsterdam, The Netherlands. METHOD: One clinical expert and 9 observers observed ventilated premature born babies simultaneously. Criterion validity was assessed by correlating the COMFORT scale with the clinical judgment regarding the amount of stress. Interobserver reliability was assessed on the clinical judgment as well as on the COMFORT scale. Diagnostic qualities were evaluated with a ROC curve. RESULTS: On 19 ventilated prematurely born babies (mean gestational age 30 weeks, mean birth weight 1385 gm), one clinical expert and 9 observers made 30 paired observations. The criterion validity of the COMFORT scale was good (Pearson's r of 0.84). The interobserver reliability of the clinical judgment was very good (weighted Kappa 0.84). The interobserver reliability of each item varied from good to almost perfect (weighted Kappa of 0.64 for muscle tone to 1.00 on heart rate). The reliability of the total COMFORT scale score was satisfying (intra-class correlation coefficient of 0.94). The diagnostic quality of the COMFORT scale was excellent, at a cut-off point of 20 the sensitivity was 100 percent, the specificity was 77 percent, and the area under the curve (AUC) of 0.95. CONCLUSION: In this first evaluation, the COMFORT scale appears to be a valid and reliable measurement tool to assess the stress of ventilated prematurely born babies.

Female↗
PubMedDate not supplied

Randomized controlled trial of kangaroo care: cardiorespiratory and thermal effects on healthy preterm infants.

PURPOSE: To determine the safety and effects on healthy preterm infants of three continuous hours of kangaroo care (KC) compared to standard NICU care by measuring cardiorespiratory and thermal responses. DESIGN: Randomized controlled trial-pretest-test-posttest control group design. SAMPLE: Twenty-four healthy preterm infants (33-35 weeks gestation at birth) nearing discharge. Eleven of the infants received KC; 13 received standard NICU care. MAIN OUTCOME VARIABLES: Heart rate, respiratory rate, oxygen saturation, and abdominal skin temperature were manually recorded every minute. Apnea, bradycardia, periodic breathing, and regular breathing were captured continuously on a pneumocardiogram printout. Three consecutive interfeeding intervals (three hours each) on one day constituted the pretest, test, and posttest periods. RESULTS: Mean cardiorespiratory and temperature outcomes remained within clinically acceptable ranges during KC. Apnea, bradycardia, and periodic breathing were absent during KC. Regular breathing increased for infants receiving KC compared to infants receiving standard NICU care.

Body Temperature↗
PubMed1999

Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994.

BACKGROUND: The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used. RESULTS: We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces. CONCLUSIONS: Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population.

Adult↗
PubMed2000

Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey.

BACKGROUND: The principal objectives of this study were to examine the relationship between cigarette smoking and periodontitis and to estimate the proportion of periodontitis in the United States adult population that is attributable to cigarette smoking. METHODS: Data were derived from the Third National Health and Nutrition Examination Survey, a nationally representative multipurpose health survey conducted in 1988 to 1994. Participants were interviewed about tobacco use and examined by dentists trained to use standardized clinical criteria. Analysis was limited to dentate persons aged > or =18 years with complete clinical periodontal data and information on tobacco use and important covariates (n = 12,329). Data were weighted to provide U.S. national estimates, and analyses accounted for the complex sample design. We defined periodontitis as the presence of > or =1 site with clinical periodontal attachment level > or =4 mm apical to the cemento-enamel junction and probing depth > or =4 mm. Current cigarette smokers were those who had smoked > or =100 cigarettes over their lifetime and smoked at the time of the interview; former smokers had smoked > or =100 cigarettes but did not currently smoke; and never smokers had not smoked > or =100 cigarettes in their lifetime. RESULTS: We found that 27.9% (95% confidence interval [CI]: +/-1.8%) of dentate adults were current smokers and 23.3% (95% CI: +/-1.2%) were former smokers. Overall, 9.2% (95% CI: +/-1.4%) of dentate adults met our case definition for periodontitis, which projects to about 15 million cases of periodontitis among U.S. adults. Modeling with multiple logistic regression revealed that current smokers were about 4 times as likely as persons who had never smoked to have periodontitis (prevalence odds ratio [ORp] = 3.97; 95% CI, 3.20-4.93), after adjusting for age, gender, race/ethnicity, education, and income:poverty ratio. Former smokers were more likely than persons who had never smoked to have periodontitis (ORp = 1.68; 95% CI, 1.31-2.17). Among current smokers, there was a dose-response relationship between cigarettes smoked per day and the odds of periodontitis (P <0.000001), ranging from ORp = 2.79 (95% CI, 1.90-4.10) for < or =9 cigarettes per day to ORp = 5.88 (95% CI, 4.03-8.58) for > or =31 cigarettes per day. Among former smokers, the odds of periodontitis declined with the number of years since quitting, from ORp = 3.22 (95% CI, 2.18-4.76) for 0 to 2 years to ORp = 1.15 (95% CI, 0.83-1.60) for > or =11 years. Applying standard epidemiologic formulas for the attributable fraction for the population, we calculated that 41.9% of periodontitis cases (6.4 million cases) in the U.S. adult population were attributable to current cigarette smoking and 10.9% (1.7 million cases) to former smoking. Among current smokers, 74.8% of their periodontitis was attributable to smoking. CONCLUSIONS: Based on findings from this study and numerous other reports, we conclude that smoking is a major risk factor for periodontitis and may be responsible for more than half of periodontitis cases among adults in the United States. A large proportion of adult periodontitis may be preventable through prevention and cessation of cigarette smoking.

Adolescent↗
PubMed2002

The role of cigarette smoking in the association between periodontal disease and coronary heart disease.

BACKGROUND: Cigarette smoking is a significant risk factor for both coronary heart disease and periodontal disease. The goal of this study was to better understand the role of smoking in the relationship between periodontal disease and heart attack history. METHODS: The study population consisted of 5,285 participants in the Third National Health and Nutrition Examination Survey (NHANES) during 1988-1994 and who were age 40 years or older when examined. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES. RESULTS: After adjustment for potential confounders, we only found significant associations between periodontal loss of attachment (LOA) and heart attack history for smokers, with odds ratios and 95% confidence interval (CI) of 2.64 (1.48 to 4.71), 3.84 (1.22 to 12.10) and 5.87 (1.91 to 18.00) for those with 2.0 to 2.99, 3.0 to 3.99, and 4 mm or more mean LOA, respectively. When the analysis was stratified by smoking status and tertile of age at heart attack, the statistically significant associations were limited to smokers who had a heart attack between the ages of 25 and 50 years, with odds ratios and 95% Cl associated with increasing mean LOA for this group of 3.29 (1.35 to 8.04), 7.32 (1.60 to 33.51), and 8.04 (1.91 to 18.00), respectively. CONCLUSIONS: These results suggest that cigarette smoking is a necessary cofactor in the relationship between periodontal disease and coronary heart disease, and the increase in risk appears to be age dependent. However, the key role played by smoking in the etiology of both periodontal and heart diseases makes it difficult to determine how much of the observed association resulted from periodontal disease.

Adult↗
PubMed2005

Prevalence of clinical attachment loss in adolescents in Santo Domingo, Dominican Republic.

BACKGROUND: Data on periodontal conditions in adolescents in the Dominican Republic are scarce. The aim of the present cross-sectional study was to estimate the prevalence of periodontal attachment loss among Dominican adolescents. This study did not attempt to classify the disease into aggressive and chronic periodontitis. METHODS: A random sample of 2,007 Dominican adolescents was obtained. A probability, weighted sample was selected using a complex, multi-stage probability sampling design. The study was clustered in 26 schools and 106 classes. The study subjects were clinically examined under field conditions by a single calibrated examiner who measured gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. RESULTS: The prevalence of clinical attachment loss > or = 1 mm was 49.5%, with the prevalence ranging between 48.7% and 50.2%, depending on age and gender. Clinical attachment loss > or = 2 mm was found in 15% of the students and attachment loss > or = 3 mm in 4.0% of the students. Logistic regression model revealed that only age significantly increased the probability of having clinical attachment loss. CONCLUSION: We conclude that clinical attachment loss is common in adolescents in Santo Domingo, Dominican Republic, suggesting the necessity for improved standards of prevention, diagnosis, and treatment of these lesions.

Adolescent↗
PubMed2006

The role of individual and neighborhood social factors on periodontitis: the third National Health and Nutrition Examination Survey.

BACKGROUND: This study investigates whether race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics are independently associated with periodontitis in adults>or=18 years of age who participated in the third National Health and Nutrition Examination Survey (NHANES III). METHODS: Analyses were limited to participants in NHANES III who self-identified as non-Hispanic black, non-Hispanic white, or Mexican American, received a periodontal examination, and whose records were linked to the 1990 U.S. Census data (N=13,090). Periodontitis was investigated using a combination of clinical attachment loss and probing depth. Marginal logistic regression models were used to assess the association of race/ethnicity, individual income, education, and neighborhood socioeconomic characteristics with periodontitis before and after adjusting for selected covariates. A survey program was used to account for the survey sampling design and for the intraneighborhood correlation of outcomes of participants selected from the same neighborhood. RESULTS: Race/ethnicity, education, and neighborhood socioeconomic conditions were associated with periodontitis before and after controlling for selected covariates. After adjustment, blacks were twice (1.58 to 2.53) as likely to have periodontitis as whites. Compared to those with more than a high school education, those with less than a high school diploma were twice (1.48 to 2.89) as likely to have periodontitis. Individuals living in a neighborhood in the lowest tertile of the socioeconomic score were 1.81 times (1.36 to 2.41) more likely to have periodontitis than those living in a neighborhood in the highest tertile of the socioeconomic score. CONCLUSION: This study indicates that race/ethnicity, individual education, and neighborhood socioeconomic circumstances are important for periodontal health.

Adolescent↗
PubMed2006

Trends in hospitalization and sociodemographic factors in diabetic and nondiabetic populations in Germany: national health survey, 1990-1992 and 1998.

OBJECTIVES: We examined time trends of hospitalization, a main outcome measure in health care, in the diabetic and nondiabetic populations in Germany and their associations with sociodemographic variables. METHODS: Using data from 2 national health surveys, we estimated hospital days per person-year in the diabetic and nondiabetic populations in 1998 (n=5422) and 1990-1992 (n=7363) in Germany. We used Poisson regression to estimate relative risks and interaction of secular time with age, gender, and educational level, considering the cluster sample design of the study. RESULTS: Hospital days per person-year decreased between 1990-1992 and 1998--from 3.59 (95% confidence interval [CI]=2.59, 4.97) to 3.14 (95% CI=2.16, 4.56) for the diabetic population and from 1.38 (95% CI=1.23, 1.55) to 1.33 (95% CI=1.17, 1.51) for the nondiabetic population--but the decrease was not statistically significant. In the diabetic population, the decrease tended to be more pronounced (interaction year x time not significant; P=.756). Also, there was a notable decrease in men and in the group aged 25 to 39 years, and a decrease in both high- and low-educational-level subjects. CONCLUSIONS: There seems to have been a larger decrease in hospitalization in the diabetic population than in the nondiabetic population in Germany. An increase in social disparity in this health outcome measure in the diabetic population could not be confirmed.

Adult↗
PubMed2006

Education and diabetes in a racially and ethnically diverse population.

OBJECTIVES: We used data from the National Health Interview Survey (1997-2002) to examine the association between education and the prevalence of diabetes in US adults and whether this relation differs by race/ethnicity. METHODS: The analyses were limited to non-Hispanic Blacks, non-Hispanic Whites, and Hispanics. SUDAAN was used to account for the complex sampling design. RESULTS: Educational attainment was inversely associated with the prevalence of diabetes. Individuals with less than a high-school diploma were 1.6 (95% confidence interval [CI]=1.4, 1.8) times more likely to have diabetes than those with at least a bachelor's degree. Whites and Hispanics exhibited a significant relation between diabetes and having less than a high-school education (odds ratio [OR]=1.7; 95% CI=1.5, 2.0; and OR=1.6; 95% CI=1.1, 2.3, respectively). In addition, the odds of having diabetes was stronger for women (OR=1.9; 95% CI=1.6, 2.4) than for men (OR=1.4; 95% CI=1.1, 1.6) CONCLUSIONS: Educational attainment was inversely associated with diabetes prevalence among Whites, Hispanics, and women but not among Blacks. Education may have a different effect on diabetes health among different racial/ethnic groups.

Adult↗
PubMed1991

Characteristics of a random sample of emergency food program users in New York: I. Food pantries.

Food pantry users throughout New York State were studied and many demographic differences found between New York City and Upstate New York respondents. Seven percent of households had no income and median income as percent of the poverty level was 59 percent. Slightly more than 40 percent were spending over 60 percent of their incomes on housing. The data from this survey, the first in New York State to employ a random sampling design, demonstrate a sizable gap between household needs and available resources.

Adult↗
PubMed1992

The social impact of dental problems and visits.

OBJECTIVES: The purpose of this analysis was to assess selected social consequences of maintaining oral health and treating oral diseases. The associations among socioeconomic and demographic factors with time lost from work or school and reductions in normal activities are explored. METHODS: Data were gathered as part of the 1989 National Health Interview Survey from 50,000 US households (117,000 individuals), representing 240 million persons. The oral health care supplement was analyzed using the software SUDAAN to produce standard errors for estimates based on complex multistage sample designs. RESULTS: Because of dental visits or problems, 148,000 hours of work were lost per 100,000 workers, 117,000 hours of school were lost per 100,000 school-age children, and 17,000 activity days beyond work and school time were restricted per 100,000 individuals in 1989. Exploratory analyses suggest that sociodemographic groups have different patterns of such time loss and of reduced normal activities. CONCLUSIONS: Overall, there is low social impact individually from dental visits and oral conditions. At the societal level, however, such problems and treatments among disadvantaged groups appear to have a greater impact.

Absenteeism↗
PubMed1997

Inappropriate drug prescriptions for elderly residents of board and care facilities.

OBJECTIVES: Using 1993 data, this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes. METHODS: Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design. RESULTS: Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis. CONCLUSIONS: The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted.

Aged↗
PubMed2000

Firearm storage patterns in US homes with children.

OBJECTIVES: This study determined the prevalence and storage patterns of firearms in US homes with children. METHODS: We analyzed data from the 1994 National Health Interview Survey and Year 2000 objectives supplement. A multistage sample design was used to represent the civilian noninstitutionalized US population. RESULTS: Respondents from 35% of the homes with children younger than 18 years (representing more than 22 million children in more than 11 million homes) reported having at least 1 firearm. Among homes with children and firearms, 43% had at least 1 unlocked firearm (i.e., not in a locked place and not locked with a trigger lock or other locking mechanism). Overall, 9% kept firearms unlocked and loaded, and 4% kept them unlocked, unloaded, and stored with ammunition; thus, a total of 13% of the homes with children and firearms--1.4 million homes with 2.6 million children--stored firearms in a manner most accessible to children. In contrast, 39% of these families kept firearms locked, unloaded, and separate from ammunition. CONCLUSIONS: Many children live in homes with firearms that are stored in an accessible manner. Efforts to prevent children's access to firearms are needed.

Adolescent↗
PubMed2001

Same-sex romantic attraction and experiences of violence in adolescence.

OBJECTIVES: Recent national attention to hate crimes committed against lesbian, gay, and bisexual youths has highlighted the need to understand this group's experiences of violence. Using nationally representative data, we examine the associations between romantic attraction and experiences of violence, as well as the risk of witnessing violence and perpetrating violence against others. METHODS: Data from the National Longitudinal Study of Adolescent Health were examined. Youths reporting same-sex and both-sex romantic attractions were compared with those reporting other-sex attractions. Survey logistic regression was used to control for sample design effects. RESULTS: Youths who report same-sex or both-sex romantic attraction are more likely to experience extreme forms of violence than youths who report other-sex attraction. Youths reporting same-sex and both-sex romantic attractions are also more likely to witness violence. The higher incidence of violence perpetrated by youths attracted to the same sex is explained by their experiences of violence. CONCLUSIONS: These findings provide strong evidence that youths reporting same-sex or both-sex romantic attraction are at greater risk for experiencing, witnessing, and perpetrating violence.

Adolescent↗
PubMed2001

Adolescent sexual orientation and suicide risk: evidence from a national study.

OBJECTIVES: Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. METHODS: Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. RESULTS: There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. CONCLUSIONS: The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide.

Adolescent↗
PubMed2002

Adolescent same-sex romantic attractions and relationships: implications for substance use and abuse.

OBJECTIVES: Nationally representative data were used to examine associations of romantic attractions and relationships with substance use and abuse. METHODS: Data from the Add Health Study were examined. Youths reporting same-sex and both-sex romantic attractions and relationships were compared with those reporting opposite-sex attractions. Survey regression and logistic regression were used to control for sample design effects. RESULTS: In the case of certain outcomes, romantic attraction affected males differently than females. Youths with both-sex attractions were at a somewhat higher risk for substance use and abuse than were heterosexual youths; females with same-sex attractions were also at higher risk for some outcomes. Sexual-minority youths varied little from heterosexual youths in regard to trajectories of substance use and abuse. CONCLUSIONS: These findings highlight the importance of distinguishing between youths with only same-sex attractions and those with both-sex attractions. These findings also call into question previous findings indicating that sexual-minority youths are automatically "at risk."

Adolescent↗
PubMed2004

Diabetes prevalence among Puerto Rican adults in New York City, NY, 2000.

This study assessed the prevalence of diagnosed diabetes and associated characteristics among Puerto Rican adults in New York City, NY, with a random-digit-dialed telephone survey with a dual-frame sampling design. Overall, 11.3% (95% confidence interval = 8.7%, 14.0%) had diagnosed diabetes; diabetes was significantly related to age, obesity, and family history; and the prevalence was high among those with the least education. This study showed the ability to obtain critically needed diabetes information from ethnic minorities at the local level.

Adolescent↗