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961.
Adelmann PK 《Journal of health care for the poor and underserved》2004,15(1):99-112
Low-income older adults have higher rates of many medical disorders than those with higher income, but rates of urinary incontinence have not been examined in this population. A random sample of older Medicaid recipients was interviewed (n=910) and medical records examined for the subset with urinary incontinence (n=236). Nursing home residents were randomly selected from Medicaid enrollment files (n=480). Forty-two percent of community residents reported urinary incontinence, with higher rates among women, older respondents, and whites. The medical records for only 22% of community-dwellers contained a diagnosis of urinary incontinence, compared with 77% for nursing home residents. Type of urinary incontinence was specified for 65% of diagnosed community dwellers and 7% of diagnosed nursing home residents. Urinary incontinence rates are high among Medicaid recipients compared with estimates from general population studies, but detection rates are lower for community-dwellers. Physicians may need to do more among low-income older adults in order to detect urinary incontinence. 相似文献
962.
Regional variations in breast cancer among california teachers 总被引:2,自引:0,他引:2
Reynolds P Hurley S Goldberg DE Anton-Culver H Bernstein L Deapen D Horn-Ross PL Peel D Pinder R Ross RK West D Wright WE Ziogas A 《Epidemiology (Cambridge, Mass.)》2004,15(6):746-754
BACKGROUND: Observed regional differences in breast cancer incidence could provide valuable clues to the etiology of this disease. The pattern of historically higher breast cancer rates among residents of California's San Francisco Bay and Southern Coastal areas is evident in the disease experience among members of the California Teachers Study. This large cohort study has followed female professional school employees for cancer incidence since 1995 and has collected extensive information on breast cancer risk factors. METHODS: Between 1996 and 1999, invasive breast cancer was diagnosed in 1562 of the 115,611 cohort members who could be geocoded to a California address in 1995 and who had no previous breast cancer diagnosis. Adjusted hazard rate ratios (HRs) were estimated through multivariate Cox proportional hazards modeling. RESULTS: Rates were higher for cohort members in the San Francisco Bay area (HR = 1.22; 95% confidence interval = 1.06-1.40) and Southern Coastal area (1.16; 1.04-1.30) compared with those in the rest of California. The distributions of variables representing socioeconomic status, urbanization, and personal risk factors were consistent with higher risks for cohort members residing in the San Francisco Bay and Southern Coastal areas. Adjustment for these factors, however, did not explain regional differences in incidence, resulting in HRs that remained elevated for these 2 areas. CONCLUSION: Regional differences in breast cancer incidence in this large, well-defined cohort are not easily explained by known risk factors. 相似文献
963.
Comparison of logistic regression and neural network analysis applied to predicting living setting after hip fracture 总被引:1,自引:0,他引:1
Ottenbacher KJ Linn RT Smith PM Illig SB Mancuso M Granger CV 《Annals of epidemiology》2004,14(8):551-559
PURPOSE: Describe and compare the characteristics of artificial neural networks and logistic regression to develop prediction models in epidemiological research. METHODS: The sample included 3708 persons with hip fracture from 46 different states included in the Uniform Data System for Medical Rehabilitation. Mean age was 75.5 years (sd=14.2), 73.7% of patients were female, and 82% were non-Hispanic white. Average length of stay was 17.0 days (sd=10.6). The primary outcome measure was living setting (at home vs. not at home) at 80 to 180 days after discharge. RESULTS: Statistically significant variables (p <.05) in the logistic model included follow-up therapy, sphincter control, self-care ability, marital status, age, and length of stay. Areas under the receiver operating characteristic curves were 0.67 for logistic regression and 0.73 for neural network analysis. Calibration curves indicated a slightly better fit for the neural network model. CONCLUSIONS: Follow-up therapy and independent bowel and/or bladder function were strong predictors of living at home up to 6 months after hospitalization for hip fracture. No practical differences were found between the predictive ability of logistic regression and neural network analysis in this sample. 相似文献
964.
Williams PR 《Journal of exposure analysis and environmental epidemiology》2004,14(7):498-515
The ability to communicate effectively the degree or magnitude of public exposures or health risks is essential for risk assessors and risk managers. Various guidelines exist for communicating environmental and public health risks, including recommended approaches for putting risk data into proper context. Although it remains unclear as to which approach is the most useful or appropriate under different circumstances, risk comparisons are a popular choice for conveying the significance of or providing a better perspective on a particular chemical exposure or health risk. In this paper, several different types of risk comparisons are described that are frequently used in the private and public sectors, and these are illustrated using a variety of examples from the literature. These approaches include: (1) intrachemical comparisons, (2) interchemical comparisons, (3) comparisons to background levels of risk, (4) comparisons to theoretical risks or safety levels, and (5) comparisons to other actions or activities. The primary purpose of this paper is to summarize and briefly discuss the advantages and limitations of these risk communication approaches. The evolving field of risk communication is also discussed, including ongoing research on public risk perceptions and alternative methods for communicating risk magnitudes and data uncertainties. 相似文献
965.
Thompson P 《Hospitals & health networks / AHA》2004,78(7):86, 4
Uncertainty about the future does not justify delaying action. It's time to redefine work roles and competencies needed to deliver quality care. 相似文献
966.
Hepatic proteins and nutrition assessment 总被引:9,自引:0,他引:9
Serum hepatic protein (albumin, transferrin, and prealbumin) levels have historically been linked in clinical practice to nutritional status. This paradigm can be traced to two conventional categories of malnutrition: kwashiorkor and marasmus. Explanations for both of these conditions evolved before knowledge of the inflammatory processes of acute and chronic illness were known. Substantial literature on the inflammatory process and its effects on hepatic protein metabolism has replaced previous reports suggesting that nutritional status and protein intake are the significant correlates with serum hepatic protein levels. Compelling evidence suggests that serum hepatic protein levels correlate with morbidity and mortality. Thus, serum hepatic protein levels are useful indicators of severity of illness. They help identify those who are the most likely to develop malnutrition, even if well nourished prior to trauma or the onset of illness. Furthermore, hepatic protein levels do not accurately measure nutritional repletion. Low serum levels indicate that a patient is very ill and probably requires aggressive and closely monitored medical nutrition therapy. 相似文献
967.
Baeten JM Richardson BA Bankson DD Wener MH Kreiss JK Lavreys L Mandaliya K Bwayo JJ McClelland RS 《The American journal of clinical nutrition》2004,79(2):218-225
BACKGROUND: Serum retinol is the most commonly used indicator of vitamin A status. Retinol is transported in a 1-to-1 complex with retinol-binding protein (RBP). RBP is easy and inexpensive to measure, and studies have shown a high correlation between concentrations of RBP and concentrations of retinol. The performance of RBP in the context of infection or protein malnutrition, however, has not been evaluated. OBJECTIVE: Our aim was to determine whether RBP is a good surrogate measure for retinol in the context of HIV-1 infection, protein malnutrition, and the acute phase response. DESIGN: The relation between RBP and retinol was examined in a cross-sectional study of 600 Kenyan women. RESULTS: There was a high correlation between concentrations of RBP and those of retinol (r = 0.88). When equimolar cutoffs were used, RBP predicted marginal vitamin A status (retinol < 1.05 micro mol/L) with 93% sensitivity and 75% specificity and vitamin A deficiency (retinol < 0.70 micro mol/L) with 91% sensitivity and 94% specificity. Similarly high sensitivities and specificities were found among subgroups with HIV-1 infection, a positive acute phase response, and protein malnutrition. Protein malnutrition and a positive acute phase response were common, especially among HIV-1-infected women, and were independently and synergistically associated with lower RBP concentrations. CONCLUSIONS: Equimolar RBP cutoffs predict vitamin A deficiency with high sensitivity and specificity, even in the context of infection and protein malnutrition. Like retinol, RBP may not accurately identify true vitamin A status under all conditions, because the acute phase response and protein malnutrition depress RBP concentrations. However, RBP may be a simple, inexpensive tool for assessment of vitamin A deficiency in population studies. 相似文献
968.
Rollins P McGehee VJ Echelle M 《The Journal of the Oklahoma State Medical Association》2004,97(9):374-380
Oklahoma has demonstrated a decline in vaccine coverage levels in children over the past two years, moving from a national ranking of 31st in 2000 to 48th in 2002. This decline has prompted a review of available evidence to identify approaches to move the state toward national averages and ultimately to the Healthy People 2010 Objectives. Oklahoma is one of nine states that are well below the established goal of 80% vaccine coverage for children. Oklahoma is near the bottom of this group with an estimated level of only 65%, placing not only Oklahomans at risk but the nation as well. The following is a plan aimed at both the health department and all health care professionals. Indeed, without physician involvement, the situation will not improve. 相似文献
969.
Over the last few years, telepsychiatry services in Michigan have been developed by LifeWays, a Medicaid-managed behavioural health-care organization. The project had four phases, involving the introduction of telepsychiatry services between a rural and an urban clinic, to a crisis intervention centre, to a youth detention centre and to patients' homes. The role of organizational issues in the success of the programme was examined through patient interviews, provider interviews, patient and provider pre- and post-project focus groups, and service documents. Utilization data were obtained from activity logs and patient charts. During the study, 297 clients received 578 teleconsultations. Almost 97% of the telepsychiatry visits were scheduled. Telemedicine usage varied between the four project phases. The reasons for its variation in use included provider roles, existing organizational strategic goals and resources, the inherent organizational culture and quirks, and leadership and managerial factors. The major difficulties stemmed from the providers and the organization itself. There is tremendous potential for telepsychiatry and the ways in which organizational variables can be managed to influence the success of telepsychiatry programmes deserve further study. 相似文献
970.
Kaufman CE Beals J Mitchell CM Lemaster P Fickenscher A The Pathways Of Choice Healthy Ways Project Teams 《Culture, health & sexuality》2004,6(4):301-318
This paper examines the relationship of risky sexual behaviour to stress and trauma-often the mediators of the content and structure of everyday life-among young American Indians. School, work, social life, and home life bring about demands and stresses for youth; choices young people make may depend on the quantity and content of those demands. Traumatic events or highly distressing situations may shatter fragile (or even resilient) systems of external and internal support from which youth may draw. American Indians live in some of the most impoverished areas of the country, where everyday life includes a heavy burden of stress and trauma. Using data from a representative sample of youth from a Northern Plains tribe, bivariate and adjusted ordered logit models are used to show that stress and trauma do play a role in the sexual decision-making of young people, especially young women. For example, young women who have experienced a trauma have a 20% probability of having had multiple casual partners in the prior year compared to 9% for those who have not experiences a trauma. Types and levels of stress and trauma also make a difference by gender. 相似文献