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PubMed2005

Is the national nutrition survey in Japan representative of the entire Japanese population?

OBJECTIVE: We examined the representativeness of the sample used in the National Nutrition Survey in Japan (J-NNS). METHODS: The distribution of the J-NNS sample from 1995 to 2000 was compared with that of the national census with respect to gender, age group, place of residence, and number of household members. RESULTS: In the survey sample, as compared with the national census distributions, the proportion of females was 1% to 2% larger, the proportion of individuals who were 20 to 39 y of age was a few percentages smaller, and a slight bias toward rural areas was seen. Among individuals who were 20 to 59 y of age, the proportion of individuals who lived in single-person households was 50% to 66% of that found in the national census. Observed disparities between the sample and the population were minimal except in the case of the proportion of individuals who lived alone. CONCLUSIONS: The sample used in the J-NNS is generally representative of the entire Japanese population with the exception of individuals in single-person households.

Adult↗
PubMed2006

[Different uses of home blood pressure measurement in the diagnosis and monitoring of hypertension].

OBJECTIVE: To find differences between measurements of clinical blood pressure and self-monitored home blood pressure measurement (HBPM). DESIGN: Descriptive study developed in a general population census. SETTING: Primary care. SUBJECTS: A total of 1411 subjects > or =18 years old were selected by stratified randomized sampling. METHODS: A skilled nurse made 3 clinical blood pressure (CBP) measurements, and trained patients or their relatives in HBPM, doing 12 in one day. CBP and HBPM employed an electronic device (OMRON 705CP). RESULTS: A total of 12 HBPM from 1184 subjects (52% women) were completed, with a mean age of 47.6 (SD, 17.2); 195 subjects were known to have hypertension. White-coat effect was diagnosed in 14.9% of subjects with normal pressure, 22.3% of hypertense patients treated and 57.6% of subjects with suspicion of isolated clinical hypertension. Possible isolated clinical hypertension was diagnosed in 10% of subjects without hypertension. White Coat normal pressure was found in 2.3% of untreated subjects and 4.7% of subjects with treated hypertension. 20.7% of subjects with hypertension poorly controlled in the clinic were considered pseudo-refractory (11.4% at the end of dosage interval). 77% of subjects conducted HBPM on their own and 89% thought it easy to do so. CONCLUSION: Incorporation of HBPM into daily medical practice could avoid 20%-30% of possible mistakes in diagnosis and monitoring of hypertense patients.

Adult↗
PubMed1996

Marketing midwifery education: findings from a survey.

OBJECTIVE: to collect information from a sample of identified customers (midwives and midwifery managers employed by health authorities and trusts) in order to develop a marketing strategy for a Department of Nursing, Midwifery and Health Care. DESIGN: two descriptive and analytical surveys using questionnaires. SETTING: mid- and west Wales, UK. SUBJECTS: randomly selected sample of 75 midwives and census sample of eight midwifery managers working within the National Health Service. MEASUREMENTS AND FINDINGS: quantitative and qualitative data collection methods. KEY CONCLUSIONS: organisations have to define, and listen carefully, to their customers and offer courses which are appropriate, related to clinical midwifery practice and have titles that accurately reflect the content. Midwives are enthusiastically committed to continuing education despite the current difficulties. Word of mouth and personal recommendation remains the most effective form of advertising. University departments of nursing and midwifery can easily become removed from clinical practice. Education assists practitioners in changing and adapting to a new order; it is also crucial in developing skills in critical thinking and analysis. New skills are needed if practice is to improve. IMPLICATIONS FOR PRACTICE: academic departments can easily become remote and out of touch with the needs of clinicians and midwifery managers. Departments must take steps to define the customer, listen carefully to what they want and make every effort to provide continuing education for midwives that is relevant, responsive, accessible and attainable. The benefits of education also must be marketed.

Adult↗
PubMed1998

Reducing cigarette sales to minors in an urban setting: issues and opportunities for merchant intervention.

INTRODUCTION: Intervention studies to reduce cigarette sales to minors have been conducted primarily in suburban settings. Little is known about sociocultural factors influencing cigarette sales to minors in urban settings. This study sought to determine sociodemographic and cultural factors that may play a role in cigarette sales and in efforts to reduce sales to minors in urban areas. METHODS: Merchant education and follow-up surveys were conducted in small local stores in predominantly African-American urban census tracts in Baltimore. The stores had prior evidence of cigarette sales to minors. RESULTS: Merchants reported hostility (66%) and foul language (64%) when they requested youth identification. Youthful-oriented advertising of cigarettes was highly prevalent in all stores and moreso in stores owned and staffed by Asian merchants. Advertising with specific youthful content was predictive (OR = 3.97; 95% CI = 1.70, 9.23; P = .0014) of higher requests for cigarettes from minors. CONCLUSIONS: Youth-oriented cigarette advertising is a prevalent environmental risk for urban youth. Differences between Asian and African-American merchants suggest socioethnic factors may be an influential component of illegal sales and educational campaigns to reduce smoking among minors.

Adolescent↗
PubMed1999

Social class, race/ethnicity, and incidence of breast, cervix, colon, lung, and prostate cancer among Asian, Black, Hispanic, and White residents of the San Francisco Bay Area, 1988-92 (United States).

BACKGROUND: To date only eight US studies have simultaneously examined cancer incidence in relation to social class and race/ethnicity; all but one included only black and white Americans. To address gaps in knowledge we thus investigated socioeconomic gradients in cancer incidence among four mutually exclusive US racial/ethnic groups-- Asian and Pacific Islander, black, Hispanic, and white-- for five major cancer sites: breast, cervix, colon, lung, and prostate cancer. METHODS: We generated age-adjusted cancer incidence rates stratified by socioeconomic position using: (a) geocoded cancer registry records, (b) census population counts, and (c) 1990 census block-group socioeconomic measures. Cases (n = 70,899) were diagnosed between 1988 and 1992 and lived in seven counties located in California's San Francisco Bay Area. RESULTS: Incidence rates varied as much if not more by socioeconomic position than by race/ethnicity, and for each site the magnitude - and in some cases direction - of the socioeconomic gradient differed by race/ethnicity and, where applicable, by gender. Breast cancer incidence increased with affluence only among Hispanic women. Incidence of cervical cancer increased with socioeconomic deprivation among all four racial/ethnic groups, with trends strongest among white women. Lung cancer incidence increased with socioeconomic deprivation among all but Hispanics, for whom incidence increased with affluence. Colon and prostate cancer incidence were inconsistently associated with socioeconomic position. CONCLUSIONS: These complex patterns defy easy generalization and illustrate why US cancer data should be stratified by socioeconomic position, along with race/ethnicity and gender, so as to improve cancer surveillance, research, and control.

Adolescent↗
PubMed2002

Intestinal parasitoses among Wayampi Indians from French Guiana.

Intestinal parasitism and its epidemiological characteristics were studied in an isolated Amerindian population from Upper Oyapock (French Guiana) that has retained its traditional social and cultural specificities. This population consisted of 138 Wayampi Indians, 68 adults and 70 children (below the age of 15 years), with a sex ratio (M/F) of 0.86, spread over the four villages of the community of Trois Sauts, corresponding to more than two thirds of the population recorded as inhabiting the sector in the last census (375 inhabitants). Fecal examination combined the direct examination of fresh feces with the quantitative techniques of Kato-Katz method, Baermann and MIF staining. Overall, 92% of the subjects were found to have intestinal parasites, 85% if only direct examination of fresh stools was taken into account. Fourteen species of human parasite were identified: seven protozoa and seven helminths. We observed in particular 1) a high frequency of hookworm infection due to Necator americanus. Over 50% of subjects were affected, with a range of 25% to 75% according to the village, but with only moderate parasite loads; 2) a high level of parasitism by E. histolytica/E. dispar (17%), Stongyloides stercoralis (16%) and Hymenolepis nana (18%); 3) a lower level of parasitism by Ascaris lumbricoides and very low levels (almost absent) of Trichiuris trichiura; 4) the absence of Schistosoma and fluke eggs. With the exception of H. nana, which was more frequent in children than in adults, there was no significant difference in the level of parasitism according to sex and age. Although the Wayampi of French Guiana are French citizens and consequently have quite high incomes and ready access to clinics and medicines, intestinal parasites are far from under control in this population. A lack of fecal hygiene and the habit of walking barefoot are widespread in the unchanging Amazonian environment and contribute to this phenomenon.

Adolescent↗
PubMed1991

The effects of census undercount adjustment on congressional apportionment.

"This article shows that undercount adjustment [of the 1990 U.S. census] will probably reallocate one [in] three House seats across the states. The adjustment's impact may depend on the method used and the assumptions underlying undercount estimates. Using regression analysis to reduce sampling error in undercount estimates from dual-systems analysis, however, eliminates sensitivity to all but the most extreme changes in assumptions. Generally, adjustment will more likely affect large states than small ones, and large states with proportionately many urban Black and Hispanic residents will likely gain seats at the expense of large states with few such residents."

Americas↗
PubMed2004

A population study of the association between hospitalization for alcoholism among employees in different socio-economic classes and the risk of mobility out of, or within, the workforce.

BACKGROUND: Alcohol problems can increase the risk of downward mobility within, or mobility out of, the workforce. The magnitude of this risk has been unclear, as has also been the question whether the risk is different for men and women, for different socio-economic classes, and for single-living compared with co-habiting people. METHODS: The study period was 1970-1980, when unemployment was low in Sweden. Information about socio-economic status from censuses was linked to hospitalization for alcoholism, alcohol psychosis and alcohol intoxication (AAA) over the period 1970-1975 in Stockholm County in persons aged 20-49 years in 1970 and gainfully employed in the same socio-economic category in both 1970 and 1975, and to general population data. The standardized rate ratio for mobility out of the workforce and for downward socio-economic mobility was calculated for those hospitalized with AAA. RESULTS: There was a statistically significant risk of mobility out of the workforce over the period 1976-1980 in both sexes and in all socio-economic groups. The relative risk was 6.63 for male skilled and semi-skilled manual workers and 9.52 for non-manual employees at medium and high level, while the corresponding figures were lower for women. The absolute risk of leaving the workforce was lowest in non-manual employees at medium and high level. The relative risk was reduced in persons who were co-habiting. CONCLUSIONS: Severe alcohol problems are powerful determinants of downward mobility within, or mobility out of, the workforce in both sexes and in all socio-economic categories.

Alcoholism↗
PubMed1997

Objective assessment of risk maps of tick-borne encephalitis and Lyme borreliosis based on spatial patterns of located cases.

BACKGROUND: Clusters of infection can indicate the underlying risk pattern of an endemic disease. Retrospective epidemiological data have been used to map the risk of tick-borne encephalitis (TBE) and Lyme borreliosis (LB) in the Central Bohemian region of the Czech Republic. METHODS: Both reported places of infection and patients' residences were entered in a geographical information system; their distance distribution and census data were used to model density of the population at risk. Point-pattern analysis and non-parametric kernel smoothing of points of infection were applied to compute the risk maps. Tick flagging and direct immunofluorescence assay were used to probe true LB-risk in the field. RESULTS: Tick-borne encephalitis infections proved to be more clustered than those of LB which was widespread; however, the most prominent clusters of both diseases largely correspond to each other. The estimated LB risk correlated well with tangible disease challenge as assessed from the tick abundance and Borrelia infection rates at 15 selected localities surveyed annually. CONCLUSION: The risk of LB is widely and smoothly distributed over the area studied, apparently following tick habitats wherever they occur, while TBE is confined to a subset of these locations.

Czech Republic↗
PubMed1999

Prescribing of beta-2 agonists and inhaled steroids in England: trends between 1992 and 1998, and association with material deprivation, chronic illness and asthma mortality rates.

BACKGROUND: British Thoracic Society guidelines published in 1990, revised in 1993 and 1997, recommended that general practitioners should make greater use of inhaled steroids in the management of asthma. British Thoracic Society guidelines have also been published on the management of chronic obstructive pulmonary disease. The objective of this study was to examine trends in the prescribing of beta-2 agonists and inhaled steroids in England between 1992 and 1998, and to investigate the variation at health authority level in the use of these drugs. METHODS: This was an observational study using prescribing analysis and cost (PACT) data, mortality data and data from the 1991 Census for all 100 health authorities in England. RESULTS: The number of defined daily doses of beta-2 agonists prescribed per quarter increased by 20 per cent, from 142 million to 170 million between June 1992 and March 1998. The number of defined daily doses of inhaled steroids prescribed per quarter increased by 78 per cent during the same period, from 69.9 million to 124.7 million. The ratio of inhaled steroids to beta-2 agonists increased from 0.49 to 0.73. The number of items per 1000 specific therapeutic group age-sex related prescribing units (STAR-PUs) in 1997 in health authorities in England varied from 41 to 115 for beta-2 agonists and from 24 to 68 for inhaled steroids. The ratio of the number of items of inhaled steroids to beta-2 agonists varied from 0.50 to 0.70. At health authority level, prescribing rates were most strongly associated with the percentage of patients reporting chronic illness (correlation coefficient 0.82 for beta-2 agonists and 0.72 for inhaled steroids). There were significant negative correlations between the ratio of inhaled steroids to beta-2 agonists and both Jarman deprivation scores (r = -0.51) and chronic illness (r = -0.38). There were no significant associations between health authority prescribing rates and death rates from asthma in people aged 5-44 years. CONCLUSIONS: Prescribing of inhaled steroids has risen more quickly than that of beta-2 agonists between 1992 and 1998, resulting in a marked increase in the ratio of inhaled steroids to beta-2 agonists. At health authority level, there remains a wide variation in the use of beta-2 agonists and inhaled steroids.

Administration, Inhalation↗
PubMed2003

Cancer mortality in counties near two former nuclear materials processing facilities in Pennsylvania, 1950-1995.

There has been concern that living near nuclear installations might increase the risk of cancer, including childhood leukemia, in surrounding communities. Such concern has been voiced by residents in Armstrong and Westmoreland Counties in Western Pennsylvania in conjunction with the operation of two former nuclear materials processing facilities located in the Apollo borough and the Parks township, just three miles apart. These facilities began operating in 1957 and 1960 and processed uranium and plutonium for commercial and naval applications. To evaluate the possibility of increased cancer rates in communities around the Apollo-Parks nuclear facilities, a cancer incidence and a cancer mortality survey were conducted. The county mortality findings are reported here. Nearly 40,000 cancer deaths occurred in the population residing in Armstrong and Westmoreland Counties from 1950 through 1995. Each of these two study counties was matched for comparison to three control counties in the same region on the basis of age, race, urbanization, and socioeconomic factors available from the 1990 U.S. Census. There were over 77,000 cancer deaths in the 6 control counties during the 45 y studied. Following similar methods used by the National Cancer Institute, Standardized Mortality Ratios (SMRs) were computed as the ratio of observed numbers of cancers in the study and control counties compared to the expected number derived from general population rates of the United States. Relative risks (RR) were computed as the ratios of the SMRs for the study and the control counties. There were no significant increases in the study counties for any cancer when comparisons were made with either the U.S. population or the control counties. In particular, deaths due to cancers of the lung, bone, liver, and kidney were not more frequent in the study counties than in the control counties. These are the cancers of a priori interest given that uranium and/or plutonium might be expected to concentrate in these tissues. Deaths from all cancers combined also were not increased in the study counties, and the RRs of cancer mortality before the facilities operated (1950-1964), during plant operations (1965-1980) and after plant closure (1980-1995) were similar: 0.96, 0.95 and 0.98, respectively. For childhood leukemia mortality, the relative risk comparing the study counties with their controls before plant start-up was 1.02, while during operations (RR 0.81) and after closure (RR 0.57) the relative risks were lower. The study is limited by the correlational approach and the relatively large size of the geographic areas of the counties studied.

Adolescent↗
PubMed2001

Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized trial of ultrasound in trauma.

OBJECTIVE: There is a paucity of evidence demonstrating that emergency department (ED) ultrasound changes clinical practice in trauma patients. We hypothesized that the presence of ultrasound would affect clinical decision making as evidenced through abdominal computed tomographic (CT) scan use in blunt multiple trauma patients. METHODS: This study used a prospective randomized format in an urban county ED with Level II trauma center status (ED census, 72,000 patients per year). Participants were patients with multiple blunt injuries meeting trauma center triage criteria. Patients were randomized to receive either abdominal ultrasound or no ultrasound (control) during initial ED resuscitation. The primary outcome variable was use of abdominal CT scan in patients with and without ultrasound. RESULTS: Two hundred eight patients were enrolled. The mean age was 40 +/- 18 years, and 62% were men. Mechanism of injury was motor vehicle crash, 56%; automobile versus pedestrian, 18%; motorcycle crash, 16%; falls, 10%; and other, 10%. One hundred four ultrasound and 104 control patients were analyzed. There were no apparent differences between ultrasound and control groups in demographics, injury type, or Injury Severity Score. Fifty-four of 104 (52%) of the control group received abdominal CT scans versus 37 of 104 (36%) abdominal CT scans for the ultrasound group; mean difference in proportions was 15.9 (p < 0.01; 95% confidence interval, 2.6-29.1). CONCLUSION: In this trial, the routine use of abdominal ultrasound in the evaluation of patients with multiple blunt injuries resulted in significantly fewer abdominal CT scans being obtained. A larger trial is needed to more clearly define the clinical and financial impact of ultrasound in the management of blunt abdominal trauma.

Abdominal Injuries↗
PubMed2005

United States trends in lumbar fusion surgery for degenerative conditions.

STUDY DESIGN: Retrospective cohort study using national sample administrative data. OBJECTIVES: To determine if lumbar fusion rates increased in the 1990s and to compare lumbar fusion rates with those of other major musculoskeletal procedures. SUMMARY OF BACKGROUND DATA: Previous studies found that lumbar fusion rates rose more rapidly during the 1980s than did other types of lumbar surgery. METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1988 through 2001 to examine trends. U.S. Census data were used for calculating age and sex-adjusted population-based rates. We excluded patients with vertebral fractures, cancer, or infection. RESULTS: In 2001, over 122,000 lumbar fusions were performed nationwide for degenerative conditions. This represented a 220% increase from 1990 in fusions per 100,000. The increase accelerated after 1996, when fusion cages were approved. From 1996 to 2001, the number of lumbar fusions increased 113%, compared with 13 to 15% for hip replacement and knee arthroplasty. Rates of lumbar fusion rose most rapidly among patients aged 60 and above. The proportion of lumbar operations involving a fusion increased for all diagnoses. CONCLUSIONS: Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications.

Cohort Studies↗
PubMed2003

Occupational magnetic field exposure and neurodegenerative disease.

BACKGROUND: Several studies have identified occupational exposure to extremely low-frequency electromagnetic fields (EMF) as a potential risk factor for neurodegenerative disease, but the evidence is contradictory and inconclusive. METHODS: We conducted a cohort study to explore these associations. We studied all economically active individuals in the Swedish 1980 census (4,812,646 subjects), and followed them for neurodegenerative disease mortality from 1981 through 1995. Information about occupation was available for 1970 and 1980. A job-exposure matrix based on magnetic field measurements was used to assess EMF exposure. RESULTS: An increased risk of Alzheimer's disease mortality was observed among men exposed both in 1970 and 1980 (relative risk = 2.3; 95% confidence interval = 1.6-3.3 for exposure >/=0.5 microT). The associations were most pronounced for early-onset Alzheimer's disease mortality or with follow-up limited to 10 years after the last known occupation. Amyotrophic lateral sclerosis was not associated with EMF exposure, but the risk estimate with "electrical and electronics work" was 1.4 (95% confidence interval = 1.1-1.9). CONCLUSIONS: Our study gives some support to the hypothesis that EMF exposure increases the risk of early-onset Alzheimer's disease, and suggests that magnetic field exposure may represent a late-acting influence in the disease process. Electric shock is an unlikely explanation for the increased risk of amyotrophic lateral sclerosis in "electrical and electronics work" in this study.

Adolescent↗
PubMed2005

Prevalence of the metabolic syndrome in the island of Gran Canaria: comparison of three major diagnostic proposals.

AIMS: The present study was conducted to estimate the prevalence of the metabolic syndrome in a Canarian population, and to compare its frequency as defined by the most commonly used working definitions. METHODS: Cross-sectional population-based study. One thousand and thirty adult subjects were randomly selected from the local census of Telde, a city located on the island of Gran Canaria. Participants completed a survey questionnaire and underwent physical examination, fasting blood analyses, and a 75-g standardized oral glucose tolerance test. The prevalence of the metabolic syndrome was estimated according to the definitions proposed by the World Health Organization (WHO), the European Group for the Study of Insulin Resistance (EGIR) and the National Cholesterol Education Program (NCEP), the latter with the original (6.1 mmol/l) and the revised criterion (5.6 mmol/l) for abnormal fasting glucose. RESULTS: The adjusted prevalence of the metabolic syndrome was 28.0, 15.9, 23.0 and 28.2%, using the WHO, EGIR, NCEP and revised NCEP criteria, respectively. The measure of agreement (kappa statistic) was 0.57 between the WHO and the original NCEP definitions, and 0.61 between the WHO and the revised NCEP definitions. After excluding diabetic subjects, the agreement between the EGIR and WHO proposals was fairly good (kappa=0.70), whereas concordance of the EGIR with the original and the revised NCEP definitions was moderate (kappa=0.47 and 0.46, respectively). CONCLUSIONS: Whichever the considered diagnostic criteria, the prevalence of the metabolic syndrome in this area of the Canary Islands is greater than that observed in most other European populations.

Adult↗
PubMed1999

Socio-economic, migrant and geographic differentials in coronary heart disease occurrence in New South Wales.

OBJECTIVE: This study examines the variation in coronary heart disease (CHD) mortality and acute myocardial infarction (AMI) by socio-economic status (SES), country of birth (COB) and geography (urban/rural) in the total population of New South Wales (Australia) in 1991-95. METHOD: CHD deaths and AMI are from complete enumerations of deaths and hospital admissions, respectively; and population denominators are from census information. Data are examined separately by sex, and comparisons of SES groups (based on municipalities), COB and region are analysed using Poisson regression, after adjustment for age. RESULTS: The study identified higher risk for AMI admissions and CHD mortality in lower SES populations with significant linear trends, for both sexes, adjusted for age, region and COB. According to the population attributable fractions (PAF), 23-41% of the risk of CHD occurrence is due to SES lower than the highest quartile. The higher age-adjusted risk for CHD occurrence in rural and remote populations for both sexes, compared with urban communities, was lessened by adjustment for COB, and all but abolished when also adjusted for SES.COB analysis indicated significantly lower age-adjusted AMI admissions and CHD mortality compared with the Australian-born. CONCLUSIONS: Higher risks for CHD in rural populations compared with the capital city (Sydney) are due, in part, to lower SES, lesser migrant composition. IMPLICATIONS: Strategies for reducing CHD differentials should consider demographic factors and the fundamental need to reduce socio-economic inequalities, as well as targeting appropriate prevention measures.

Adult↗
PubMed2006

Trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand, 1981-99: one country, many stories.

BACKGROUND: Ethnicity and socio-economic position are important determinants of colorectal cancer (CRC) mortality. In this paper, we determine trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand. METHODS: Cohort studies of the entire New Zealand population for 1981-84, 1986-89, 1991-94 and 1996-99 (linking Census and mortality datasets) allowed direct determination of trends in CRC mortality by income and education. For ethnicity, we used routine unlinked Census and mortality data, but with correction factors applied for undercounting of Mâori and Pacific deaths. RESULTS: ETHNICITY: CRC mortality trends varied markedly. There were small (10-20%) decreases among non-Mâori non-Pacific people, a 50% increase among Mâori, and up to 10-fold increase among Pacific people. By 1996-99, all three ethnic groups had similar CRC mortality. SOCIO-ECONOMIC POSITION: For females, differences in CRC mortality by education and income increased over time e.g. poor females had a 40% higher CRC mortality than rich females in 1996-99, compared with no difference in 1981-84 (p for trend 0.04). In men, increases in inequality were seen by income but not education. CONCLUSION: The observed ethnic trends probably reflect differential trends in exposure to etiological risk factors. Social inequalities in colorectal cancer mortality appear to be increasing.

Adult↗
PubMed2001

Do elder emergency department patients and their informants agree about the elder's functioning?

OBJECTIVE: To compare elder patients' and their informants' ratings of the elder's physical and mental function measured by a standard instrument, the Medical Outcomes Study Short Form 12 (SF-12). METHODS: This was a randomized, cross-sectional study conducted at a university-affiliated community teaching hospital emergency department (census 65,000/year). Patients >69 years old, arriving on weekdays between 10 AM and 7 PM, able to engage in English conversation, and consenting to participate were eligible. Patients too ill to participate were excluded. Informants were people who accompanied and knew the patient. Elder patients were randomized 1:1 to receive an interview or questionnaire version of the SF-12. The questionnaire was read to people unable to read. Two trained medical students administered the instrument. The SF-12 algorithm was used to calculate physical (PCS) and mental (MCS) component scores. Oral and written versions were compared using analysis of variance. The PCS and MCS scores between patient-informant pairs were compared with a matched t-test. Alpha was 0.05. RESULTS: One hundred six patients and 55 informants were enrolled. The patients' average (+/-SD) age was 77 +/- 5 years; 59 (56%; 95% CI = 46% to 65%) were women. There was no significant difference for mode of administration in PCS (p = 0.53) or MCS (p = 0.14) scores. Patients rated themselves higher on physical function than did their proxies. There was a 4.1 (95% CI = 99 to 7.2) point difference between patients' and their proxies' physical component scores (p = 0.01). Scores on the mental component were quite similar. The mean difference between patients and proxies was 0.49 (95% CI = 3.17 to 4.16). The half point higher rating by patients was not statistically significant (p = 0.79). CONCLUSIONS: Elders' self-ratings of physical function were higher than those of proxies who knew them. There was no difference in mental function ratings between patients and their proxies. Switching from informants' to patients' reports in evaluating elders' physical function in longitudinal studies may introduce error.

Activities of Daily Living↗