Oral health-related quality of life and life-space mobility in community-dwelling older adults

OBJECTIVES: To quantify the associations between measures of oral health–related quality of life (OHRQoL) and life‐space mobility (LSM) in community‐dwelling older adults. DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS: The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community‐dwelling adults aged 65 and older. MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL and LSM. Life‐space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS: Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self‐rated oral health. CONCLUSION: OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well‐being have a significant effect on mobility and the social participation of older adults.     

Association Between Neighborhood Disadvantage and Hypertension Prevalence,Awareness, Treatment,and Control in Older Adults: Results From the University of Alabama at Birmingham Study of Aging

Objectives. We evaluated the effect of neighborhood disadvantage (ND) on older adults’ prevalence, awareness, treatment, and control of hypertension.Methods. Data were from the University of Alabama at Birmingham Study of Aging, an observational study of 1000 community-dwelling Black and White Alabamians aged 65 years and older, in 1999 to 2001. We assessed hypertension prevalence, awareness, treatment, and control with blood pressure measurements and self-report data. We assessed ND with US Census data corresponding with participants’ census tracts, created tertiles of ND, and fit models with generalized estimating equations via a logit link function with a binomial distribution. Adjusted models included variables assessing personal advantage and disadvantage, place-based factors, sociodemographics, comorbidities, and health behaviors.Results. Living in mid-ND (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.2, 2.1) and high-ND tertiles (AOR = 1.8; 95% CI = 1.3, 2.3) was associated with higher hypertension prevalence, and living in high-ND tertiles was associated with lower odds of controlled hypertension (AOR = 0.6; 95% CI = 0.4, 0.6). In adjusted models, ND was not associated with hypertension awareness or treatment.Conclusions. These findings show that neighborhood environmental factors matter for hypertension outcomes and suggest the importance of ND for hypertension management in older adults.The characteristics of the geographic spaces or neighborhoods where people live influence their health throughout the life course.1–9 The mechanisms whereby neighborhood characteristics affect individuals’ health include psychosocial and material resources in those geographic spaces. Specifically, neighborhoods have the potential to be a source of social capital, providing support to persons in need; to have physical capital, offering parks and recreation resources for physical activity; and to have human capital, generating economic output. Any of these resources can contribute to the overall well-being of individuals living there.10 Alternatively, stress caused by high crime, low social support, limited economic resources, or a lack of material resources such as health services6 may ultimately negatively affect the health of individuals living in a neighborhood. Furthermore, limited community-based assistance programs, as well as limited access to healthful foods or adequate shopping opportunities and recreational facilities11 in disadvantaged neighborhoods may also have adverse effects on health. The daily stress of living in such disadvantaged neighborhoods may place a high burden on individuals’ physiological systems, a burden which is sometimes called allostatic load.12,13These risks and benefits of neighborhood contexts may accrue over a long period of time and may affect people either right away or for many years in the future14 and lead to conditions such as hypertension. In fact, neighborhood-level psychosocial and material deprivations are particularly problematic for individuals’ cardiovascular health and for management of cardiovascular risk factors. In 2004, Diez Roux et al.15 demonstrated an association between negative environments and both cardiovascular and noncardiovascular mortality. Other researchers have found similar effects, including Mujahid et al.16 who showed that walkability, access to healthy food, greater safety, and greater social cohesion were associated with a lower likelihood of hypertension.Although these findings are useful for gaining insights into the general population, work is needed to assess the effects of neighborhood characteristics on specific, unique subpopulations. To that end, there has been a growing interest in the effects of neighborhood context on older adults because of their potentially greater sensitivity (than the general population) to the effects of their neighborhood contexts on health.8,17–22 This is particularly important, as Lawton and Simon purported in the environmental docility hypothesis,23 because, as persons age and become more ill, losing control of their ability to perform activities of daily living, they may become more sensitive to characteristics of their environments, including the neighborhoods where they live. Specifically, then, older adults’ inability to navigate through disadvantaged neighborhoods may put them at higher risk for hypertension because of more concentrated exposure to psychosocial stressors. In addition, deprivation of health services including access to physicians and pharmacies in disadvantaged neighborhoods may cause adverse outcomes. Finally, older adults’ negative perception of their neighborhood environment may have a negative impact on their likelihood of being mobile and active, even when, in reality, theirs is not an unsafe or disadvantaged neighborhood.Although there is a burgeoning literature on the relationship between neighborhood characteristics and cardiovascular outcomes and a growing interest in neighborhood effects on older adults, no work known to these authors has examined neighborhood effects on hypertension specifically among older adults. Therefore, we aimed to assess if an association exists between neighborhood disadvantage (ND), measured by a validated ND index (NDI),24 and hypertension prevalence, awareness, treatment, and control in a cohort of community-dwelling older adults.     

急性有机磷农药中毒120例的救治

0　引言　近年来 ,我科在救治急性有机磷农药 (organophos-phorus,OP)中毒方面 ,积累了一些经验 ,现报告如下 .1　对象和方法1 .1　对象　本组 1 2 0例符合《急诊急救学》中的诊断标准 [1 ](男 2 9例 ,女 91例 ) ,年龄 1 .5～ 70岁 ,平均 2 8.6岁 .经口中毒 99例 ,经皮肤中毒 2 1例 .轻度中毒 1 5例 ,中度中毒 42例 ,重度 (含极重度 )中毒 6 3例 . 1 996年 39例 ,1 997年 43例 ,1 998年 38例 . DDV 79例 ,乐果 2 0例 ,混合性中毒 1 0例 ,水胺磷 3例 ,氧化乐果、 391 1、 1 0 5 9、对硫磷各 2例 ,敌百虫 1例 ,药名不详 1 0例 .服毒量 >2 5 …     

Chronic pancreatitis: ultrasonic features

A retrospective analysis of 84 ultrasound examinations (in 77 patients) was performed to assess the frequency of sonographic findings in chronic pancreatitis. The findings included: inhomogeneously increased echogenicity in 53% of these examinations, focal or diffuse enlargement in 41%, focal dense echoes in 40%, pseudocyst formation in 21%, and a hypoechoic head mass in 7%. Thirteen per cent of our patients had a normal sonogram. Several presentations of chronic pancreatitis not previously described in the sonographic literature included: pancreatic or common bile duct enlargement or pseudocyst formation with otherwise normal-appearing glands. There was no direct relationship between the presence of focal high-intensity echoes within the pancreatic parenchyma and the presence of radiographic calcification. There was no difference in the frequency of ultrasonic abnormalities between patients with and without clinical evidence of pancreatic insufficiency. These results indicate that the sonographic findings in chronic pancreatitis are significantly more varied than previous reports would indicate.     

T1N0M0 bronchogenic carcinoma: assessment by CT

We reviewed medical records and conventional chest radiographs that showed a solitary T1N0M0 nodule in 23 patients who had non-oat-cell bronchogenic carcinoma. No patient had evidence of metastases, either on the chest radiograph or clinically. All patients underwent computed tomography (CT) examination of the thorax, including the adrenal glands. Only one patient (4%) had mediastinal lymph nodes greater than 1 cm in diameter accessible to mediastinotomy; anterior mediastinotomy confirmed metastatic spread in this patient, which precluded curative resection. Three patients each had a mildly enlarged (2 cm or less) adrenal gland; however, follow-up study suggested that metastasis was not the cause of adrenal enlargement in these patients. This study reinforces concern over whether CT is warranted in the preoperative assessment of T1N0M0 bronchogenic carcinoma.     

The Impact on Breastfeeding and Pregnancy Status of Household Contraceptive Distribution in Rural Haiti

This paper presents data from an experimental project which distributed oral contraceptives, foam, and condoms to households in three rural areas of Haiti between January 1978 and March 1980. The contraceptive distribution had little apparent impact on traditional, prolonged breastfeeding patterns, and the percentage of women pregnant after eight months of field operations declined over 35 per cent in the two areas where contraceptive acceptance and use were highest. (Am J Public Health 1982; 72:825-838.)     

子宫颈妊娠1例

１　病例报告　患者,２８岁,因“停经３ｍｏ余,不规则阴道流血２ｍｏ余,于１９９９－０６－３０入院．患者１９９３年足月妊娠剖宫产一男婴．末次月经１９９９－０３－１２,０６－１４始阴道少量流血,无腹痛．０４－２８当地医院Ｂ超提示“不全流产”,未行清宫术．...