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Biomedical subjects

J M Shultz

Publications and source records attributed to J M Shultz.

At least 19 recordsLinked to original sources
PubMed2001

Impact of aging on eating behaviors, food choices, nutrition, and health status.

People eat less and make different food choices as they get older. It is unclear what impact these dietary changes may have on health status. However, lower food intake among the elderly has been associated with lower intakes of calcium, iron, zinc, B vitamins and vitamin E. Low energy intakes or low nutrient density of the diet may increase the risk of diet-related illnesses and so pose a health problem. Several factors may influence this observed decline in energy intake. Older adults tend to consume less energy-dense sweets and fast foods, and consume more energy-dilute grains, vegetables and fruits. Daily volume of foods and beverages also declines as a function of age. Physiological changes associated with age, including slower gastric emptying, altered hormonal responses, decreased basal metabolic rate, and altered taste and smell may also contribute to lowered energy intake. Other factors such as marital status, income, education, socioeconomic status, diet-related attitudes and beliefs, and convenience likely play a role as well. Many age-related nutritional problems may be remedied to some extent by providing nutrient-dense meals through home delivery or meal congregate programs. Management of medical and dental problems and the provision of vitamin and mineral supplements may also be effective. More studies that integrate nutrition research, public health intervention, and outcomes research are needed to determine the impact of diet on nutrition, health, and overall quality of life.

Aged↗
PubMed2000

HIV-related high risk sexual behaviors and practices among women in Bogotá, Colombia.

Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.

Adolescent↗
PubMed1999

The impact of insurance status on drug abuse treatment completion.

This article discusses the impact of insurance status on drug abuse treatment completion in a not-for-profit organization, presents demographic findings, mentions financial obstacles to paying for treatment, and describes the relationship between different variables: treatment modalities versus type of drug, treatment modality versus length of stay, reason for discharge versus type of drug, and reason of discharge versus treatment status (completed/not completed). Baseline data (n = 6,539) for the period 1990-1997 was analyzed. For the insurance status analysis we randomly selected and analyzed 1,153 client entries. A statistical software package (STATA) was used for a combination of bivariate and multivariate analysis. Our results indicated, consistent with expectations, that lack of health insurance is associated significantly with not completing treatment. Therefore, new strategies and mechanisms of payment should be created to overcome these obstacles and facilitate treatment completion for clients without insurance coverage.

Ambulatory Care↗
PubMed1995

Recorded criteria as a "gold standard" for sensitivity and specificity estimates of surveillance of nosocomial infection: a novel method to measure job performance.

OBJECTIVES: To compare the accuracy of infection control practitioners' (ICPs') classifications of operative site infection in Florida Consortium for Infection Control (FCIC) hospitals, in two time periods, 1990 to 1991 and 1991 to 1992, and to estimate the effect of duration of surveillance experience on that accuracy. METHODS: Medical record reviewers examined records of all patients classified by an ICP as infected, to distinguish false-positives from true infections based on evidence of standard infection criteria and the ICP's contemporaneous clinical observations. Reviewers also examined a random sample of 100 records from patients classified as noninfected for evidence of undetected infections (false-negatives). These observations permitted estimates of the sensitivity and specificity of each ICP's classification of infection status. SETTING: Fourteen FCIC community hospitals at which performance of 16 ICPs was monitored. RESULTS: There was a strong linear trend relating increasing sensitivity to numbers of years of ICP surveillance experience (P < .001). For ICPs with < 4 years of experience, satisfactory sensitivity (> or = 80%) was reached in only one of 10 ICP-years of observation. For ICPs with > or = 4 years' experience, satisfactory sensitivity was achieved for 14 of 18 person-years (P = .001). Estimated specificity was 97% to 100% for all ICP-years observed. CONCLUSIONS: ICPs with < 4 years of surveillance experience in FCIC community hospitals rarely achieved a satisfactory sensitivity estimate, whereas ICPs with > or = 4 years' experience generally did. Monitoring ICP surveillance accuracy through retrospective medical record audits offers an objective approach to evaluating ICP performance and to interpreting infection rates at different hospitals.

Case-Control Studies↗
PubMed1995

An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses.

OBJECTIVE: To investigate an apparent excess of operative site infections (OSI) reported according to doctor's diagnosis (presumptive OSI) by applying objective criteria for classification (documented OSI). To examine potential consequences of habitual overdiagnosis of OSI. DESIGN: A case-control design was used to examine the clinical course of 18 case patients (12 presumptive OSI, six documented OSI) and 18 matched controls. Comparisons also were made between presumptive and documented OSI patients. SETTING: A nonteaching community hospital. PATIENTS: Thirty-six patients having laminectomies done by the same surgeon. INTERVENTION: Implementation of objective criteria for diagnosis of confirmed OSI and reclassification of presumptive OSI patients. RESULTS: Postoperatively, the frequency of specific adverse events within the operative site (including postoperative hematoma or bleeding; wound necrosis, dehiscence, or sinus tract; and dural tear) was 83% for documented OSI patients, contrasted with 16.7% for presumptive OSI patients (P < .01) and controls (P = .007). Median days of inpatient stay were 27 for documented OSI, contrasted with 9.5 for presumptive OSI (P = .01) and 7 for controls (P < .001). CONCLUSION: Documented OSI patients were found to have significantly more adverse findings and longer lengths of stay than presumptive OSI patients or controls. The similarity of findings for presumptive OSI patients and controls suggests that the apparent excess frequency of OSI was caused by incorrect diagnosis. Whereas doctor's diagnosis may be useful as an initial screen for OSI, use of objective criteria for confirming OSI may avert the consequences of overdiagnosis including excessive length of stay and unnecessary therapy, which lead to elevated healthcare costs and threaten a physician's practice.

Aged↗
PubMed1993

Intervention to discontinue parenteral antimicrobial therapy in hospitalized patients with urinary tract infection, skin and soft tissue infection, or no evident infection.

OBJECTIVES: In a previous study, we found that unsolicited recommendations to physicians of medically stable patients with pneumonia to suspend parenteral antimicrobials shortened hospital length of stay (LOS) significantly. In this study, we made similar recommendations to physicians treating patients with different indications for parenteral antimicrobials, to examine the effect on LOS. METHODS: A nurse-interventionist presented randomly assigned physicians with nonconfrontational suggestions to discontinue parenteral antimicrobials by substituting comparable oral antimicrobials or stopping treatment. Patients were being treated for urinary tract infection, skin infection, or no evident infection. Blinded observers evaluated in-hospital and 30-day postdischarge patient courses. Methodologies were identical to the previous study. RESULTS: There were 70 physician-patient episodes (49 intervened episodes, 21 control episodes). In 44 episodes (90%), compliant physicians discontinued parenteral antimicrobials. Compared to a median postrandomization LOS of 2.5 days (range, 0 to 40.5) for 21 patients of control physicians, the corresponding LOS for 44 patients of compliant physicians was two days (range, 0 to 8; P = 1.0), and for five patients of noncompliant physicians, five days (range, 3 to 11; P = 0.04). The combined occurrence of all adverse events detected in this and the previous study was 11% for patients of control physicians, compared to 14% for patients of compliant physicians (P = 0.2), and 19% for patients of noncompliant physicians (P < 0.05). CONCLUSIONS: For patients of compliant physicians hospitalized with urinary tract infection, skin and soft tissue infection, or no evident infection, cessation of parenteral antimicrobials did not significantly shorten LOS, due to brief LOS of patients of control physicians. Patients of noncompliant physicians experienced more adverse events and prolonged LOS. The appropriateness of routine continuous use of parenteral antimicrobials in medically stable inpatients is questioned.

Aged↗
PubMed1993

Alcohol-related mortality in California, 1980 to 1989.

OBJECTIVES: This study sought to examine the impact of alcohol use and misuse on mortality in California during the 1980s. METHODS: Alcohol-Related Disease Impact estimation software and California vital statistics data were used to calculate alcohol-related mortality, mortality rates, and years of potential life lost. Statistical tests were applied to detect significant differences in death rates by sex and race/ethnicity. Time trends in death rates for a subset of alcohol-defined diagnoses were examined using regression analysis. RESULTS: An estimated 6.2% of all deaths for California residents during 1989 were related to alcohol, making it one of the top 10 leading causes of death. Injury diagnoses were major contributors to the total estimated number of alcohol-related deaths and years of potential life lost before age 65. Alcohol-related mortality rates were significantly higher for men and for Blacks. However, age-adjusted death rates for alcohol-defined diagnoses declined significantly from 1980 to 1989. CONCLUSIONS: A structured data-base approach to analyzing mortality data represents an important advance for alcohol research that has implications for policy and program planning. Future refinements and enhancements to the disease impact estimation methodology will add precision to determining how alcohol use and misuse affect public health in California.

Accidents, Traffic↗
PubMed1993

The epidemiology of AIDS and HIV infection in Costa Rica.

This article describes and assesses the epidemiology of AIDS and HIV infection in Costa Rica. A total of 283 AIDS cases were reported in the country between 1983, when the first cases were diagnosed, and the end of August 1991. This placed Costa Rica third among the seven Central American countries--both in terms of cumulative AIDS incidence and the cumulative number of cases. Despite a continued small number of hemophilia and transfusion-associated AIDS cases, screening of blood and blood products has provided a high degree of safety for the blood supply. The high male:female ratios of reported AIDS cases (11:1) and HIV infections (14:1) and the high proportion of AIDS cases (72%) transmitted by male-to-male sexual contact give grounds for considering Costa Rica to be a Pattern I country--one where the disease is transmitted, primarily among homosexual/bisexual males. However, increasing numbers of heterosexual and perinatal cases, high rates of HIV infection among pregnant women, and existing patterns of bisexuality are consistent with a possible shift toward a Pattern I/II epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Intervention to discontinue parenteral antimicrobial therapy in patients hospitalized with pulmonary infections: effect on shortening patient stay.

OBJECTIVES: Current efforts to contain anti-microbial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay. METHODS: A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians with nonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and 30-day postdischarge courses of patients of physicians who had been contacted by the nurse (cases) and those who had not (controls). RESULTS: Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was $884/patient). In 11 (21%) episodes, case physicians continued parenteral therapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was $704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups. CONCLUSIONS: The major cost-saving potential for shifting from parenteral to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.

Aged↗
PubMed1991

Epidemiology of acute rheumatic fever in a multiethnic, multiracial urban community: the Miami-Dade County experience.

During the mid-1980s, several US communities experienced outbreaks of acute rheumatic fever (ARF), often involving predominantly white, middle-class individuals living in suburban or rural settings. The medical records of all patients diagnosed with ARF in Miami-Dade County, Florida, between 1984 and 1988 were reviewed. Thirty-five cases met the revised Jones criteria and were considered definite; four additional cases were classified as probable. Carditis was present in 54%. Of the 39 patients, 32 (82%) were black. The annual incidence of ARF among black children aged 5-14 years was 12.25 per 100,000 compared to 0.71 for other (non-Hispanic white plus Hispanic) children (P less than .001). ARF was centered in the inner city, where the incidence among black children reached 15.21. Despite the multiethnic, multiracial character of Miami-Dade County and the rapid influx of immigrants, ARF in this community remains primarily a disease of underprivileged, black inner-city children.

Acute Disease↗
PubMed1990

HIV-1 counseling and testing sites, Minnesota: analysis of trends in client characteristics.

We report here a summary of the data obtained from two HIV-1 antibody counseling and testing sites in Minneapolis-St. Paul for the first 48 months of operation (24,911 persons tested). The HIV-1 antibody seroprevalence rate for all persons tested was 5 percent. The highest seroprevalence rates were in male homosexual/bisexual intravenous drug users (23 percent) and homosexual/bisexual men (13 percent). There was a significant decrease in the HIV-1 antibody seroprevalence rate among clients during the 48-month period from 14 percent in the first six months to 3 percent in the last six months. This decrease coincided with an increase in the number of low-risk female clients and low-risk heterosexual male clients, and a decrease in the number of homosexual/bisexual males participating in the programs. These findings suggest the need for development and implementation of other strategies to identify and reach persons at highest risk for HIV-1 infection.

AIDS Serodiagnosis↗
PubMed1990

Assessing the damage from cigarette smoking in New York State.

Although there is clear evidence that smoking is the leading preventable cause of death in the United States today, almost one third of American adults continue to smoke. To promote public awareness of smoking's adverse effects, we applied a previously established methodology to estimate the impact of cigarette smoking in New York State. Using New York State-specific mortality data, cigarette smoking prevalence rates, and total health care costs, we found that cigarette smoking caused almost 27,000 deaths in 1985, resulting in 335,000 years of potential life lost (mean, 12 years per person). The estimated annual cost of smoking totaled +4.7 billion, including direct (health care) and indirect (lost income and productivity) costs from smoking-attributable deaths and illness. The New York State Department of Health publicized these findings to gain support for a statewide regulation for smoking control in public places. This methodology can easily be applied elsewhere to assess the adverse impact of smoking and to support smoking control activities.

Adult↗
PubMed1990

A new dimension in health information reporting.

The health care industry is under increasing pressure to demonstrate competence and quality of care, to identify and address potential risks, to participate in education and medical research and to manage resources, all with level-funded or reduced operating budgets. The Health Records Analysis Unit at the General Hospital (Grey Nuns) of Edmonton responds to these pressures by providing hospital staff with the data they need to identify cost drivers, to address issues related to quality of care and risk management, and to augment the institution's education and research functions. Furthermore, the HRAU analysts have saved valuable staff time by expertly providing meaningful data that are essential to the efficient, proactive operation of the hospital of the 1990s.

Computers, Mainframe↗