Determinants of osteoporosis prevention in low-income Mexican-American women

BACKGROUND: Prevention is the most cost-effective means of managing osteoporosis. However, little is known about osteoporosis-related preventive practices in Mexican-American women. We examined factors that might influence women's decision to start preventive measures for osteoporosis. METHODS: Information was gathered through a cross-sectional survey of low-income Mexican-American women who were seen at two clinics in southern Texas. RESULTS: Of the 270 participants, 37% reported calcium supplementation, and 41% reported regular weight-bearing exercise to prevent osteoporosis. Fifty (41%) of the postmenopausal women were currently using hormone replacement therapy. Only 15% of the premenopausal and 13% of the postmenopausal women recalled that their health care provider had counseled them about prevention. Multivariate analysis showed that public education, bone densitometry evaluation, knowledge of osteoporosis, and counseling were determinants of prevention. CONCLUSION: Although osteoporosis is a preventable condition, our findings suggest that the majority of Mexican-American women do not receive adequate preventive measures or counseling about osteoporosis. Furthermore, we found that their health care provider's counseling about osteoporosis was a major determinant of osteoporosis prevention in these women.     

Hospital and emergency department use by young low-income children

BACKGROUND: Limited data are available concerning determinants of health care service usage by low-income young children. OBJECTIVES: To explore predictors of hospitalization and emergency department (ED) use by young children of low-income families by using the Aday and Andersen Access Framework. METHODS: Low-income women (n = 474) with a child younger than 6 years completed a structured face-to-face interview at human service offices or Women, Infants, and Children (WIC) clinics in four central Ohio counties. Women were considered low-income if they or their child were Medicaid eligible or uninsured. Data were collected for both the mother and the index child on sociodemographic status, health services use, health status, and access to care. RESULTS: Fifteen percent of the children had been hospitalized the previous year, and half had an ED visit. Hospitalization was significantly related to maternal hospitalization the previous year (OR = 2.5), child age younger than 1 year old (OR = 2.1) and more than two chronic conditions (OR = 2.2). Maternal ED usage in the last year (OR = 2.2), Medicaid fee for service plan (OR = 1.7), and rural residence (OR = 2.0) were predictive of ED use. CONCLUSIONS: Predisposing characteristics (maternal hospital/ED use) were predictive of both hospitalization and ED use by the index child. Enabling characteristics (fee-for-service Medicaid plan, rurality) were only predictive of ED use, and need characteristics (child's health) were only predictive of hospitalization. Further research to explore linkages between maternal and child use of health care services as well as the effect of changes in health care access, managed care, and other innovations on hospitalization and ED use in young, low-income children is recommended.     

Appropriate use of drugs by elderly people

The effectiveness and safety of prescribed medication theoretically depends on the patient correctly following the prescriber's instructions. However, patient compliance is often difficult to achieve. This paper discusses reasons for this in relation to elderly people, and attempts to remedy the situation are reviewed.     

Physical therapy use by community-based older people

BACKGROUND AND PURPOSE: Little information is available on factors associated with physical therapy use. Identifying the characteristics of people who use physical therapy and some of the factors associated with its use is a useful first step in determining whether disparities exist in physical therapy use. The purpose of this study was to identify factors associated with physical therapy use by community-based older people. SUBJECTS: The subjects were community-based people 65 years of age or older who participated in the Medicare Current Beneficiary Survey and had at least one physician encounter (N=38,312 person-years across 20,227 individuals). METHODS: Logit and ordinary least squares regression analyses were conducted to identify factors associated with physical therapy use. RESULTS: Several measures of health and function were associated with physical therapy use. Several demographic, insurance, and geographic characteristics also were associated with physical therapy use. Income, education, having supplemental private insurance, participating in a managed care plan, and physical therapist supply were positively associated with physical therapy use. Age was negatively associated with physical therapy use. For people who saw a physical therapist, amount of physical therapy received was positively associated with income, having supplemental private insurance, living in a metropolitan area, physical therapist supply, and being African American. Amount of physical therapy received was negatively associated with being in a managed care plan. DISCUSSION AND CONCLUSIONS: Variation in physical therapy use, explained by factors other than need, suggests potential underuse or overuse of physical therapy by community-based older people.     

Determinants of balance confidence in community-dwelling elderly people

BACKGROUND AND PURPOSE: The fear of falling can have detrimental effects on physical function in the elderly population, but the relationship between a persons' confidence in the ability to maintain balance and actual balance ability and functional mobility is not known. The extent to which balance confidence can be explained by balance performance, functional mobility, and sociodemographic, psychosocial, and health-related factors was the focus of this study. SUBJECTS: The subjects were 50 community-dwelling elderly people, aged 65 to 95 years (mean=81.7, SD=6.7). METHODS: Balance was measured using the Berg Balance Scale. Functional mobility was measured using the Timed Up Go Test. The Activities-specific Balance Scale was used to assess balance confidence. Data were analyzed using Pearson correlation, multiple regression analysis, and t tests. RESULTS: Fifty-seven percent of the variance in balance confidence could be explained by balance performance. Functional mobility and subject characteristics examined in this study did not contribute to balance confidence. DISCUSSION AND CONCLUSION: Balance performance alone is a strong determinant of balance confidence in community-dwelling elderly people.     

A randomized controlled trial of a video module to increase U.S. poison center use by low-income parents

Context. U.S. poison centers decrease medical visits by providing telephone advice for home management of potential poisonings, but are underutilized by low-income African-American and Latino parents, and those with limited English proficiency, due to lack of knowledge and misconceptions about poison centers. Objectives. To assess the effectiveness of a poison prevention video module in improving knowledge, behavior, and behavioral intention concerning use of poison centers in a population of low-income, language-diverse adults attending parenting courses offered by a community organization. Methods. A randomized, blinded, controlled trial was conducted at 16 parenting course sites of a community organization and included 297 participants. The organization's instructors presented the video module (intervention) or the usual class curriculum (control). Participants completed questionnaires at baseline and a telephone interview 2–4 weeks later. Changes from baseline to follow-up were compared between the intervention and control groups using analysis of variance and Chi-square tests. Intervention group participants were stratified by English proficiency and compared to assess baseline and follow-up responses by language. Results. After the intervention, participants in the intervention group had a significantly greater increase in knowledge about the poison center, were more likely to have the correct poison center phone number at home, and had greater behavioral intention to use the poison center compared to control group participants. At baseline, Spanish-primary-language participants with limited English proficiency had less knowledge about the poison center, were less likely to have the poison center number at home, and had lower behavioral intention to use the poison center than English proficient participants, but significantly improved after the intervention. Conclusions. This video module, when presented by a community organization's instructors, was highly effective in improving knowledge, behavior, and behavioral intention concerning use of poison centers within a low-income, language-diverse population.     

Condom use predictors for low-income African American women

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.     

老年人合理用药问题分析

随着社会生产力的发展,科学的进步,人们生活和卫生保健的改善,人的平均寿命显著地延长。老年人口迅速增长,发达国家和发展中国家均面临着人口老龄化的问题。老年人患病率也相应增加,成为药品市场的最大消费人群,据统计,其消费的处方药品占23%～40%,非处方药品占40%～50%。老年人由于各器官功能随老龄化而衰退,对药物的耐受程度明显下降,有文献报告,超过60岁的老年人因为药物治疗而发生不良反应的危险性是一般成人的2.5倍。因此,要重视老年人合理用药问题。     

Don't hang up: use of the telephone by people with communication difficulties.

Joan Murphy describes a research project funded by the Scottish Office Home and Health Department, that investigated telephone use by people with communication difficulties.     

Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation.

OBJECTIVE: To evaluate the frequency and extent of prosthetic use by people with lower limb amputation and identify factors that facilitate prosthetic use. DESIGN AND SETTING: Five-year follow-up survey using the Prosthetic Profile of the Amputee (PPA) questionnaire and Dillman's mailing strategy. SUBJECTS: Adults with unilateral transtibial and transfemoral amputation (n = 396) who had completed a prosthetic training program. MAIN OUTCOME MEASURES: Frequency of prosthetic wear, in hours per week, and active prosthetic use for locomotion indoors and outdoors. RESULTS: Eighty-five percent of the respondents (mean age 62.9+/-15.9yrs) were prosthetic wearers; 53% used their prosthesis for locomotion indoors, and 64% outdoors. Ability to don the prosthesis (p < .001), locomotor capabilities with the prosthesis (p < .001), walking distances (p < .001), automaticity of gait (p < .05), and assistive devices used (p < .001) were the main factors related to the three outcome measures. People with transfemoral amputation reported greater difficulties in donning their prosthesis (p < .01) and a significantly higher rate of falls (p < .001). CONCLUSION: The majority of people with lower limb amputation wear their prosthesis daily. With the exception of resources (prosthetic laboratory and means of transportation), all enabling factors investigated were significantly associated with the outcome measures.     

Determinants of self-report outcome measures in people with knee osteoarthritis

OBJECTIVES: To identify the determinants of self-report mobility measures in people with knee osteoarthritis (OA) and to compare self-report measures with physical performance. DESIGN: Cross-sectional, prospective. SETTING: Motor performance laboratory and human mobility research center. PARTICIPANTS: A convenient sample of 54 participants with medial compartment knee OA (32 women, 22 men; age 68.3+/-8.7y; range, 50-87y). Three participants were excluded because of the presence of lateral knee OA on radiographs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reports were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Performance measures included the six-minute walk test (6MWT), Timed Up & Go (TUG) test, and a standardized stair-climbing task (STR). RESULTS: Stepwise linear regression analysis identified models that included pain, quadriceps and hamstrings strength, and depression to explain 62% to 73% of the variance in scores on the physical functioning subscale of the WOMAC and the SF-36. These self-report measures had a moderate relation (r range, .46-.64) with performance measures (6MWT, TUG, STR). CONCLUSIONS: Self-report measures were strongly related to pain; physical performance measures were strongly related to self-efficacy. Regression models showed that self-report scores reflect pain, knee strength, and depression. The relation between self-report and performance measures was moderate, suggesting that these examine different aspects of mobility.     

Manual wheelchair propulsion pattern use by people with multiple sclerosis

Purpose.?To determine the most commonly used manual wheelchair propulsion pattern by people with multiple sclerosis (MS) and to assess which factors influence the preference.

Method.?Sixty manual wheelchair users with MS from an MS outpatient rehabilitation centre in Northern Italy were assessed on upper limb range of motion and trunk stability to determine if these factors or demographic, disease or wheelchair use history, influenced the choice of wheelchair propulsion pattern.

Results.?Fifty-four (90%) subjects used the arcing propulsion pattern, the least efficient pattern as reported in the literature. Sixteen (26.7%) subjects had impaired trunk stability and 38 (63.3%) subjects demonstrated some deficit on either extremity for active range flexion–extension. Twenty (33%) subjects had no deficits on active range flexion–extension and had normal trunk control. Upper limb range of motion and trunk stability were not significant in determining the preference for propulsion pattern (p?=?1.05 and 0.38, respectively). Demographic and disease factors and wheelchair use history were also not significant in determining propulsion pattern.

Conclusions.?The person with MS uses the least efficient pattern overall, requiring frequent repetition, although a smaller range of movement. This may be an energy conservation technique that helps in managing fatigue.     

The nurse's role in assessing alcohol use by older people

Nurses have the potential to carry out health promotion activity related to alcohol use in a range of settings where older people receive care. The majority of the literature on alcohol use in later life has focused on abuse, especially on the more common risk of drug-alcohol interactions. In order to work effectively with older people in health prevention and education, nurses need to be knowledgeable about older people's patterns of drinking, the effects of alcohol on medication and the current evidence on the harm and benefits of alcohol to health. In carrying out assessments, a skillful approach needs to be adopted in questioning older clients on what some might regard as a sensitive issue. Screening tools for the detection of alcohol abuse in the general adult population may not be valid for use with older clients. Tools specific to the detection of alcohol abuse by older people will be considered.     

Computer use among elderly people

This study investigates the literature on the state of knowledge on computer use among elderly people. Results of this review suggest that benefits may ensue if computer use is advocated. Functional limitations secondary to visual, hearing, and mobility changes; financial inadequacy; and cognitive limitation related to memory use are identified as barriers that may inhibit this population from learning how to use the computer. Methods and techniques dealing with these barriers are presented. Finally, teaching strategies that may be implemented to facilitate the learning process among elderly population on computer use are discussed and elucidated.