Changes in the differential treatment of Rajput girls in Khalapur: 1955-1975.
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Adult↗
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Results for “Educational Status--changes”
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Health-related behavior of adolescents: change over time.
A longitudinal study of the changes in health-related behavior in Israeli adolescents was undertaken in a large, comprehensive secondary school. The incidence of starting to smoke and its relationship to the development of sexual behavior was assessed. Smoking, use of drugs, sexual behavior, and drinking of alcoholic beverages at the age of 16 years was related to dropout from secondary school during the 2-year study period. The possibility of developing a model of adolescent risk behavior and its relevance to planning of health and educational services is discussed.
Adolescent↗
Education and timing of parenthood among Canadian women: a cohort analysis.
This research examines factors associated with the timing of first birth in Canada, focusing primarily on the role of women's educational attainment. Proportional hazards modelling techniques are applied to data from the 1984 Canadian Fertility Survey (CFS) in order to determine how educational attainment, estimated as close as possible to the date of first birth, influences the timing of first birth and whether the importance of this variable varies according to age cohorts. The results suggest that among a number of variables useful for distinguishing different levels of risk, educational attainment proves to be the most important predictor in the model. Education exerts a substantial positive influence on birth timing for women of all age groups. As expected, moreover, significant cohort differences are also evident, with the greatest to the smallest impact on the risk from the youngest to the oldest cohorts. These clear-cut cohort differences indicate a fundamental change in the effects of education over time, a trend most likely resulting from substantial changes in both the content and social significance of formal schooling during the past few decades.
Adolescent↗
Acquired immunodeficiency syndrome (AIDS)
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Acquired Immunodeficiency Syndrome↗
Project Redirection: evaluation of a comprehensive program for disadvantaged teenage mothers.
An evaluation of Project Redirection, a two-year demonstration program designed to help pregnant teenagers and teenage mothers, shows that teenagers from a comparison group, who were not enrolled in the demonstration program, were significantly more likely than project participants to experience a repeat pregnancy after one year, but that after two years the difference was small and nonsignificant. Likewise, at 12 months into the program, the project participants proved more likely to be using contraceptives, but by 24 months the comparison group had caught up. After one year of participation, the project teenagers were more likely than the others either to be in school or to have graduated (56 and 49 percent, respectively). However, this differential also disappeared by 24 months. Nonetheless, even at that point, project teenagers who had dropped out prior to joining the program and those who had had a repeat pregnancy were more likely to be in school or to have completed school than were similar comparison teens. Project teenagers also were somewhat more likely to have held a job during the two-year period than were teenagers not enrolled in the program. All in all, the evaluation demonstrated that teenagers who participated in the project and remained in it for more than a year had consistently better outcomes in education, employment and repeat pregnancy than any other group had. Comparison teenagers who had never participated in any special program for pregnant teenagers, on the other hand, demonstrated consistently poorer outcomes than any other group.
Adolescent↗
A clinical appraisal of patients following long-term contraception.
This study presents a clinical evaluation of private patients between the ages of 16 and 40 who have used contraceptive measures from January 1, 1961, through December 31, 1973. The clinical evaluation involves 3,746 private patients. The contraceptive methods of 641 patients (17 per cent) who have been bollowed for a total of 99,996 months (13 years each) are presented and analyzed. The patients are evaluated as to weight, blood pressure, pregnancy, pap smears. laboratory changes, pelvic surgery, breast surgery, incidence of cancer, contraceptive failures and changes in contraceptive practices over this span of time. This paper evaluates the role of such sociologic factors as education, religion, economic level, occupation, working status, changing marital status, age at the time of contraceptive choice, and the attitude of the husband with regard to long-term contraceptive therapy. Side effects have been well publicized. Safety has been questioned but essentially proved for the vast majority of the patients. Collected data enable some insight into the life style and motivation of the long-term contraceptive users.
Adolescent↗
The independence and stability of socioeconomic predictors of morbidity in systemic lupus erythematosus.
OBJECTIVE: We studied the relationship between systemic lupus erythematosus (SLE) morbidity and socioeconomic status (SES) at 5 centers. METHODS: Ninety-nine patients who met American College of Rheumatology criteria for SLE were randomly sampled at each center, balancing by race and insurance status. Subjects were interviewed for current and past SES factors, such as insurance, occupation, employment, education, and income. SLE disease activity was measured by the SLE Activity Measure (SLAM). RESULT: Higher education, private insurance/Medicare, and higher income were associated with less disease activity at diagnosis. Controlling for SES, race, and center, the best predictors of less active disease at diagnosis were private insurance/Medicare (P = 0.002) and higher education (P = 0.007). From the time of diagnosis to the study visit (mean 3.5 years), insurance, income, and employment status changed for a significant number of subjects (37%, 16%, and 21%, respectively). CONCLUSION: Private insurance or Medicare and higher education are associated with less active disease at diagnosis of SLE. Health insurance, income, and employment status are unstable measures of socioeconomic status and may explain the variability in conclusions of previous studies on the role of SES in SLE.
Adult↗
Mental status change in the elderly: recognizing and treating delirium.
Delirium is a common cause of acute mental status change in hospitalized elderly people, yet the literature and the author's clinical experience suggest that clinical nurses are often unaware of how the syndrome can present, how it differs from other types of mental status changes seen in the elderly, and what interventions are most appropriate in affected individuals. This article discusses these areas, presents original data from a study at Beth Israel Hospital, Boston, MA, concerning nursing assessment of patients with delirium, and outlines a new educational module that nurse specialists, educators, and others can use to teach clinical nurses about delirium in elderly patients.
Aged↗
Preventing heat stroke.
High temperature, mental status changes and anhidrosis constitute the classic triad of the heat stroke syndrome. Prevention should be the foremost concern. For athletes, this means gradual acclimation to a warm environment, liberal water replacement and use of the wet-bulb thermometer as a guide to activity. Other precautionary measures include preseason history and physical examination, records of pre- and post-exercise body weights, proper clothing and education. These principles are adaptable to nonathletes.
Acclimatization↗
Pediatric nursing homes. Implications of the Massachusetts experience for residential care of multiply handicapped children.
Pediatric nursing homes were established in Massachusetts in 1971, in response to the crisis created by the deinstitutionalization of children with multiple severe handicaps for whom care in the community was unrealistic. Although these residential beds provided short-term relief for the system, failure both to plan for the improved long-term survival of the children and to develop alternative community services for those whose functional and medical status changed has left fundamental problems unresolved. A review of the 421 residents of pediatric nursing homes since 1972 shows that most have been bedridden and nonverbal, requiring provision of basic care: feeding, dressing, maintaining hygiene, and sensory and motor stimulation. Three quarters of the residents were severely or profoundly retarded and had seizures. About 4 per cent died each year, and another 5 per cent were discharged; few beds were available for new admissions. Low standards of care and financial disincentives have resulted in less than optimal educational and rehabilitative services. Other states are facing similar problems, which can be resolved only through better funding and coordination of the relevant state agencies.
Certification↗
Hallucinations and ifosfamide-induced neurotoxicity.
BACKGROUND: Hallucinations as a symptom of central neurotoxicity are a known but poorly described side effect of ifosfamide. Most cases of ifosfamide-induced hallucinations have been reported with other mental status changes. METHODS: The authors interviewed six persons with ifosfamide-induced hallucinations in the presence of a clear sensorium. All patients were receiving high-dose ifosfamide as part of their bone marrow transplant procedure. RESULTS: Hallucinations occurred only when the patient's eyes were closed and, in all but one case, were reported as disturbing or frightening. Underreporting of these hallucinations by patients is likely. CONCLUSIONS: Hallucinations may be the sole or first manifestation of neurotoxicity. The incidence may be dose and infusion-time related. The clinician should be alerted for possible ifosfamide-induced hallucinations, which may occur without other signs of neurotoxicity. "Eyes-closed" hallucinatory experiences appear to be an unusual feature of this presentation. Patients anxious about this experience respond well to support and education about this occurrence. Optimal pharmacologic management of disturbed patients is unclear. If agitation becomes marked, high-potency neuroleptics (i.e., haloperidol) may be effective.
Adult↗
Cardiovascular response to gait training and ambulation in a hemiparetic heart recipient.
Little has been reported about the rehabilitation of heart recipients who experience disabling neurologic complications. This is of particular interest to physiatrists because the number of cardiac transplants is increasing and the cardiovascular response of the denervated heart to exercise is altered. The case reported here describes a 42-year-old woman who underwent heart transplantation for ischemic cardiomyopathy. One year after transplantation, the patient was hospitalized for evaluation of headaches and mental status changes. A lymphoma involving the left basal ganglia was diagnosed and the patient underwent a course of radiation therapy. She was transferred for rehabilitation of a left hemiparesis and made functional gains in mobility and self-care skills. Weekly recordings of heart rate and blood pressure were obtained before and after ambulation. Small increases in both heart rate and blood pressure were recorded after ambulation to the point of fatigue. In both parameters, the patient's maximum response was below that reported for nondisabled cardiac recipients, highlighting the need for symptom-oriented exercise guidelines in these patients.
Activities of Daily Living↗
Geriatric nutrition.
The aging process alters body composition so that nutritional status changes as we get older. The aging process shows interindividual variability in its rate of development. Determinants of the rates of aging of systems and tissues are largely genetic. Premature aging of cells and tissues is due to genetic factors and to long-term exposure to physical or chemical environments that cause irreversible tissue damage. Whereas maximal lifespan is fixed for us all, individuals vary in life expectancy both because of variability in the risk of genetic disease which shortens life and because of variable capability for avoidance of those factors in our environment which cause early aging. Early aging as well as geriatric disease foreshorten life, but both can be prevented to some extent by diet or by diet and exercise. Diseases that can be nutritionally prevented, giving us a greater chance of achieving our genetically determined lifespans, include nutritional deficiency states and chronic diet-related diseases such as non-insulin-dependent diabetes, hypertension, coronary artery disease, and cancer. Disabilities resulting from these diseases and from degenerative arthritis are also subject to modulation by diet. The nutritional requirements of the elderly are mostly similar to those of younger people. Elderly usually need fewer calories and similar nutrient intakes compared with those of younger people. Elderly with higher needs for specific nutrients include homebound or institutionalized people who lack sunlight exposure and therefore require more vitamin D. Nutritional requirements to promote longer life expectancy and freedom from disabilities that result from chronic disease include restriction of food energy and fat. Nutritional assessment of the elderly is aimed at identifying not only the presence of deficiency states but also states of nutrient excess and chronic diet-related diseases. There are certain problems in carrying out nutritional assessment in the elderly, but techniques are now available which make valid assessment possible even in the oldest old. Those who live longest have less genetic risk of premature aging, but as a result of native intelligence, education, coping skills, and higher socioeconomic status, they also have a greater likelihood of eating a diet that best meets their long-term nutritional needs. Those most at risk for developing malnutrition as they get older are those who lack food access because of poverty, because of disability resulting from chronic geriatric disease, or because of a combination of these factors. Malnutrition is found in elderly in our society who live in their own homes if they are indigent, isolated, and homebound because of disability.(ABSTRACT TRUNCATED AT 400 WORDS)
Aged↗
Functional outcome one year following cataract surgery in elderly persons.
We conducted a prospective study of 164 patients aged 70 and over who had undergone cataract removal and intraocular lens implantation to determine variables which predicted change in physical function experienced by the patients one year after cataract surgery. Path analysis was used to estimate direct and indirect effects of ADL change. Direct effects were estimated for mental status (-.35), mental status change (.51), binocular visual disability (-.39), binocular visual disability change over one year (.51), and baseline ADL (.36), with 45% of variance explained. Age and baseline mental status had important indirect effects through mental status change, and presurgical visual disability had important indirect effects through both visual disability change and mental status change. In summary, change in level of function one year after cataract surgery was not explained solely by change in vision, but was conditional on baseline function and baseline mental status and mediated in part by change in mental status.
Activities of Daily Living↗
Nursing care delivery models and nurse satisfaction.
The relative impact of various nursing care delivery models and management interventions on nurse satisfaction was assessed in 37 New Jersey hospitals. Nurses ranked pay as the most important factor, followed by autonomy and professional status. Changes in scores between pilot and comparison units were significantly different for satisfaction with interactions and task requirements. Change in satisfaction with interaction was significant for all initiatives in aggregate, as well as for each of the five types of initiatives separately. The change in satisfaction with task requirements was significant for all initiatives taken as a group and for those units that implemented reorganization, computer, and education initiatives. Even among nurses who eventually liked the new environment there was a period of initial dissatisfaction.
Humans↗
The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.
We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.
Arthritis, Rheumatoid↗
Profile of Danish women undergoing reversal of sterilization, 1978-1983.
To help identify those women who might regret undergoing sterilization, the Danish women refertilized from 1978 to 1983 were contacted by mailed questionnaire. Eighty-three percent (120/144) responded. These women were younger at the time of sterilization than Danish women sterilized in the same period (mean age 29 years versus 34 years). Furthermore, they had more children at the time of sterilization and had their first and last child at a younger age than Danish women generally, in the same age group. Their social and educational status was lower than the background population and fewer were in gainful employment. At sterilization, most of the women were in an emotionally stressful situation (e.g., marital disharmony (78% of the married women), single parenthood (28%), unwanted pregnancy (27%], or had chronic health problems in the family. Alternative contraceptive methods had not been fully explored. Thirty-eight percent complained of late secondary effects attributable to the sterilization, but the main reason for wanting reversal of sterilization was a new partner (75%). The study suggests that the psycho-social situation and contraceptive alternatives should be carefully evaluated in women requesting sterilization, especially in those below the age of 30.
Adult↗
The transition to motherhood: the intersection of structural and temporal dimensions.
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Adult↗