Health behaviors and their determinants in multiethnic, active Israeli seniors

To assess factors that affect the adoption of healthy lifestyles among a variety of active Israeli seniors, a survey was conducted in 2002 at the Peiluyada, a physical activity-oriented health fair for seniors held annually in Israel from 1995 to 2002. A multi-language, self-administered questionnaire, assessing predisposing factors, barriers and health-protective behaviors, was fielded to potential participants. Response rate at the event was 51%. Hebrew and Arabic speakers generally characterized their health as good to very good, while Russian speakers' health was rated only poor to fair. Over 80% engaged in regular physical activity, were satisfied with their diet, and conformed to international nutritional recommendations. Vaccination coverage against influenza (81%) and pneumocccocus (58%) was highest among Arabic speakers, and lowest among Russian speakers (33.5% and 12%, respectively). Higher age (> or =75 years) was significantly associated with receiving a vaccination against influenza. Major barriers to exercise included low motivation and poor physical health or disability. Health-related dietary restrictions were the leading nutritional barrier. Prominent barriers to vaccination included concerns about vaccine effectiveness (39%) and side effects (29%). Leading cues to action were a recommendation from one's doctor (67%) and from a healthcare worker (51%).     

Influence of subject eligibility criteria on compliance with National Institutes of Health guidelines for inclusion of women, minorities, and children in treatment research

BACKGROUND: Many alcohol treatment outcome studies exclude some patients with particular problems, such as psychiatric disorders, noncompliance, and homelessness. Such criteria may increase the likelihood of a study being successfully conducted, but may also have the unintended consequence of reducing a study's ability to comply with National Institutes of Health guidelines for inclusion of racial minorities, women, and children in treatment research. METHODS AND RESULTS: This paper examined this issue empirically using 5 prior studies of treatment systems enrolling over 100,000 alcohol patients. Widely used eligibility criteria in the alcohol treatment field typically exclude between one-fifth to one-third of patients from enrolling in research. Under several eligibility criteria, most notably those for drug use and social/residential instability, women and African-American patients are substantially more likely to be excluded than are men and non-African-American patients, respectively. CONCLUSIONS: In designing treatment studies with many eligibility criteria, researchers may therefore inadvertently be thwarting their own good faith efforts to ensure that a range of vulnerable populations are able to participate in research. We analyze the implications of this dilemma for the generalizability of treatment results and for research design, and provide data that may help researchers working in different treatment systems estimate the impact of various eligibility criteria.     

Age-friendly care in the Veterans Health Administration: Past,present, and future

The Veterans Health Administration (VHA) has long recognized the need for age-friendly care. VHA leadership anticipated the impact of aging World War II veterans on VA healthcare systems and in 1975 developed Geriatric Research, Education, and Clinical Centers (GRECCs) to meet this need. GRECCs catalyzed a series of innovations in geriatric models of care that span the continuum of care, most of which endure. These innovative care models also contributed to the evidence base supporting the present-day Age-Friendly Health Systems movement, with which VHA is inherently aligned. As both a provider of and payor for care, VHA is strongly incentivized to promote coordination across the continuum of care, with resultant cost savings. VHA is also a major contributor to developing the workforce that is essential for the provision of age-friendly care. As VHA continues to develop and refine innovative geriatric models of care, policymakers and non-VHA health care systems should look to VHA programs as exemplars for the development and implementation of age-friendly care.     

National and Regional Trends in Deep Vein Thrombosis Hospitalization Rates,Discharge Disposition,and Outcomes for Medicare Beneficiaries

Introduction

Older adults are at increased risk of developing deep vein thrombosis. Little is known about national trends of deep vein thrombosis hospitalizations in the context of primary and secondary prevention efforts.

Physical disability, articular, and extra-articular damage in patients with juvenile idiopathic arthritis

Data on outcome of juvenile idiopathic arthritis (JIA) from the Indian subcontinent is limited. Juvenile Arthritis Damage Index (JADI) is a newly proposed index which measures articular (JADI-A) and extra-articular damage (JADI-E). We studied the outcome of JIA using JADI in Indian patients. We assessed the damage in patients with JIA using JADI, and to see if JADI scores correlate with various parameters of damage and disease activity. We studied 89 patients of JIA (excluding enthesitis-related arthritis) with a >/=1-year duration of the disease. Besides JADI, clinical assessment included active joint count, joints with limited mobility, ESR, and CHAQ. Radiological damage was assessed according to the Dale scoring system. Correlation of JADI with various parameters was done by Spearman's rank correlation coefficient. The patient's distribution of JIA subtypes was polyarticular (47), systemic onset (SoJIA 23), oligoarticular (15), psoriatic arthritis (one) and others (three). The median duration of disease was 5 years (1-20). JADI-A ranged from 0-61 (Median 2); 60.7% of children had articular damage. Thirty-five (39.3%) patients had extra-articular damage; out of which, growth failure was the commonest. Persistent oligoarticular subtype had lesser JADI-A score as compared to SoJIA and polyarticular JIA. JADI-A correlated significantly with (p < 0.01) with radiological damage (0.538), CHAQ (0.567), JADI-E (0.513), duration of disease (0.385), and loss of education years due to disease (0.352). Further it also correlated with measures of disease activity like: ESR (0.286), duration of morning stiffness (0.258, p < 0.05), physician's global assessment (rS 0.623), and parent's global assessment (0.446), Almost two-thirds of patients with JIA had articular damage and one third had extra-articular damage. JADI is a good tool to measure damage in children with JIA.     

Per-Capita Medicare Expenditures,Primary Care Access,Mortality Rates,and the Least Healthy Cities in America

Purpose

To determine whether several measures of health care expenditures, access, and outcomes for the 25 recently identified “least healthy cities in America” differed from those in the rest of America.

Impact of Provider-led,Technology-enabled Radiology Management Program on Imaging

Objective

The study objective was to assess the impact of a provider-led, technology-enabled radiology medical management program on high-cost imaging use.

Methods

This study was performed in the ambulatory setting of an integrated healthcare system. After negotiating a risk contract with a major commercial payer, we created a physician-led radiology medical management program to help address potentially inappropriate high-cost imaging use. The radiology medical management program was enabled by a computerized physician order entry system with integrated clinical decision support and accountability tools, including (1) mandatory peer-to-peer consultation with radiologists before order completion when test utility was uncertain on the basis of order requisition; (2) quarterly practice pattern variation reports to providers; and (3) academic detailing for targeted outliers. The primary outcome measure was intensity of high-cost imaging, defined as the number of outpatient computed tomography (CT), magnetic resonance imaging (MRI), and nuclear cardiology studies per 1000 patient-months in the payer's panel. Chi-square test was used to assess trends.

Results

In 1.8 million patient-months from January 2004 to December 2009, 50,336 eligible studies were performed (54.1% CT, 40.3% MRI, 5.6% nuclear cardiology). There was a 12.0% sustained reduction in high-cost imaging intensity over the 5-year period (P < .001). The number of CT studies performed decreased from 17.5 per 1000 patient-months to 14.5 (P < .01); nuclear cardiology examinations decreased from 2.4 to 1.4 (P < .01) per 1000 patient-months. The MRI rate remained unchanged at 11 studies per 1000 patient-months.

Conclusion

A provider-led radiology medical management program enabled through health information technology and accountability tools may produce a significant reduction in high-cost imaging use.     

Medical Bankruptcy in the United States, 2007: Results of a National Study

Background

Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.

Methods

We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as “medical” based on debtors' stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.

Results

Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

Conclusions

Illness and medical bills contribute to a large and increasing share of US bankruptcies.     

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates

BACKGROUND: Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. METHODS: The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. RESULTS: Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. CONCLUSIONS: These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.     

The Oklahoma Postmenopausal Women's Health Study: recruitment and characteristics of American Indian, Asian, Black, Hispanic, and Caucasian women

Since 1994, the National Institutes of Health has required the inclusion of women and minorities in all of its sponsored clinical research. This study describes a workable recruitment strategy that embraces the National Institutes of Health requirement. We describe the recruitment pattern of the Oklahoma Postmenopausal Women's Study conducted in the general community of Oklahoma City and in surrounding areas that are both urban and rural. For the period 1994 through 1997, 491 postmenopausal women from all racial/ethnic groups in the community have participated in this study. Over 4 years of recruitment, the percentage of minority women in the study population has risen annually from 31% in 1994 to 81% in 1997. The overall percentage of minority women in the study population is currently 63.3%: American Indian, 21.8%; Asian, 3.7%; Black, 14.9%; Hispanic, 9.4%; White/American Indian Blend, 13.6%; and White, 36.7%. The recruitment approach described may be implemented in a variety of research settings. Specific recruitment approaches are described, as well as the distribution of sociodemographic and health behaviors across and within ethnic/racial groups.     

广东省中山市1990～2000年HIV流行趋势与防制现状分析

目的分析中山市各类人群艾滋病病毒/艾滋病(HIV/AIDS)的流行现状及趋势,探讨该市HIV/AIDS防制对策.方法对哨点和常规监测以及流行病学个案调查资料进行分析.结果(1)共用注射器静脉吸毒是该市HIV流行的主要传播途径;(2)该市HIV感染模式为从境外到境内,从省外到该市;(3)有从高危人群向其他人群扩散的趋势.结论该市HIV流行已进入快速增长期;及时开展健康教育为主的行为干预活动,杜绝共用针具并做好HIV感染者追踪管理,是控制HIV流行的主要手段.     

贵州省龙里县健康教育与健康促进干预防制燃煤型氟中毒的效果分析

目的探讨贵州省龙里县健康教育与健康促进干预防制燃煤污染型氟中毒的效果与经验。方法2001年开始建立县、乡、村三级健康教育网络，开展氟中毒防制知识健康教育，2004年调查病区人群的知晓率和行为改变率，并调查健康教育与健康促进干预前后环境氟与尿氟的变化情况。结果通过健康教育与健康促进干预，使龙里县目标人群氟中毒防制知识知晓率由原来的25％左右上升到65％以上；中小学生知晓率达90％以上；改炉率、烟囱出屋率、炉灶正确使用率分别由原来的64．05％、27.32％、49．73%，上升为83．54％、69．33％，、83．17％；食物干燥、食物保存、食物淘洗率分别由原来的63．43％、42．86％、68．48％上升到70．96％、74．78％、82．06％；室内空气氟下降至正常水平；大米、玉米、辣椒含氟量分别下降59．70％、67．95％、91．95％：8～12岁学生尿氟由2．13mg,／L降至1.32mg／L。结论健康教育与健康促进干预是目前防制燃煤型氟中毒的好方法，它具有覆盖面广、见效快、投资少、易巩固与提高等优点．应予广泛推广。     

A preliminary candidate approach identifies the combination of chemerin,fetuin-A,and fibroblast growth factors 19 and 21 as a potential biomarker panel of successful aging

Although the number of centenarians is growing worldwide, the potential factors influencing the aging process remain only partially elucidated. Researchers are increasingly focusing toward biomarkers as tools to shed more light on the pathophysiology of complex phenotypes, including the ability to reach successful aging, i.e., free of major chronic diseases. We therefore conducted a case-control study examining the potential associations of multiple candidate biomarkers in healthy centenarians and sex-matched healthy elderly controls. Using a case-control study of 81 centenarians (aged ≥ 100 years) selected based on the fact that they were disease-free and 46 healthy elderly controls (aged 70–80 years), serum levels of 15 different candidate biomarkers involved in the regulation of metabolism, angiogenesis, inflammation, and bone formation were measured. Of the 15 biomarkers tested, four molecules (chemerin, fetuin-A, and fibroblast growth factors [FGF] 19 and 21) were found to be independently associated with successful aging regardless of sex. Logistic regression analysis confirmed that chemerin, fetuin-A, FGF19, and FGF21 were independently associated with successful aging [predicted probability (PP) = 1 / [1 + 1 / exp (11.832 − 0.027 × (chemerin) − 0.009 × (fetuin-A) + 0.014 × (FGF19) − 0.007 × (FGF21)]. The area under the curve (AUC) of predicted probability values for the four-biomarker panel revealed that it can discriminate between centenarians and elderly controls with excellent accuracy (AUC > 0.94, P < 0.001). Although preliminary in essence and limited by the low sample size and lack of replication in other independent cohorts, our data suggest an independent association between successful aging and serum chemerin, fetuin-A, FGF19, and FGF21, which may provide novel information on the mechanisms behind the human aging process. Whether the four-biomarker panel may predict successful aging deserves further scrutiny.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-015-9776-y) contains supplementary material, which is available to authorized users.     

Impact of the severity of hypoglycemia on health - Related quality of life,productivity, resource use,and costs among US patients with type 2 diabetes

Aims

To explore the association between hypoglycemia severity and health-related quality of life (HRQoL), productivity, health care resource utilization (HCRU), and costs among patients with type 2 diabetes mellitus (T2DM).