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PubMed1995

Controversies about the clinical assessment of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common disorder which places a considerable burden on older men and health care expenses. With advances in medical technologies and the foreseeable demographic changes in the Western world, the financial and epidemiological impact of this chronic disease is expected to increase further. The management of BPH is controversial, and this article critically reviews the clinical applicability and validity of the various measures available for assessment. Few objective modalities are indicated in the routine evaluation of BPH. There is a poor correlation between objective and subjective indicators and both measures reveal a substantial variation over time. This fluctuation is mainly attributed to the natural history of the disease. The clinical value of combining objective and subjective parameters into an analytic process seems small. Disagreements about the clinical value of BPH assessment modalities have caused inconsistent practices and consequently provision of changeable health care quality. Patients seek urological counseling and relief because of burden of illness. Quality care is provided by clinicians being perceptive to patients' preferences. Provision of quality care does not inevitably generate increasing health service expenses.

Humans↗

PubMed1996

[Evaluation of symptoms in patients with benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is the most common cause of voiding dysfunction in elderly men. With the age related demographic changes in the western world, the epidemiological and economical burden of BPH is anticipated to increase. BPH is clinically diagnosed on a variety of more or less well defined symptomatic, macroscopical, and physiological criteria, whereas the histological diagnosis is straightforward. Yet, no symptom is specific for BPH and numerous other diseases have to be considered when a patient presents with symptoms of bladder outlet obstruction. A BPH questionnaire is useful when weighing the pros and cons for intervention. Furthermore, a symptom index represents a valuable indicator for the quality of care provided. Through the last decades a number of BPH questionnaires have been introduced. This article scrutinizes various BPH indices and provides an introduction to the prerequisites of clinical questionnaires.

Aged↗

PubMed1996

[Why do elderly couples use ambulatory nursing care?].

More than one million people in Germany are in need of home care and elderly caregiving wives and their caretaking husbands are an important group in the society. Demographical changes with a shift to more elderly people in relation to younger people will further increase the importance of this group. Home care service organisations play an important role in supporting these couples, but they are still rarely made use of. To optimize the support that can be rendered by home care services, information is needed on what influences the decision of elderly couples to use or not to use such services. A set of data from an earlier study about the situation of more than 300 couples aged 60 years or older is used to determine influencing factors in bivariate and multivariate analysis. The theoretical framework is a behavioural model of service use. The need for care measured by loss of function in activities of daily living turns out to be the most important factor influencing the use of home service organisations. Other variables such as e.g. disability of caregivers play a minor role. It seems that home care services are used as a kind of "last resort" if there is no other way to handle the situation. In trying to optimize home care services, the different values of factors influencing their use should be considered. It is important to take into consideration that those who solicit home care aid wish to retain their autonomy at the same time.

Activities of Daily Living↗

PubMedDate not supplied

Diagnostic yield of upper gastrointestinal endoscopy in relation to age and gender: a study of 10112 Saudi patients.

BACKGROUND/AIMS: The availability of fiberoptic endoscopy has made it relatively easy to evaluate symptoms of upper gastrointestinal disorders with a significant degree of accuracy. MATERIALS AND METHODS: To determine the pattern of upper gastrointestinal lesions in the Saudi population with particular reference to the influence of age and gender, 10,112 patients were studied. RESULTS: No abnormal findings were detected in 26.9%. The frequency of ulcer lesions was 13.7% while non-ulcer, mucosal inflammation was diagnosed with a frequency of 33.7%. In the young (less than 20 years of age), the most common lesion was duodenal ulcer or duodenitis, whereas in the elderly (above 60 years of age), esophagitis, hiatus hernia and esophageal varices were the most frequently diagnosed. The highest mean ages were observed in the group of patients with gastric and esophageal cancers (mean ages of 58.8 and 65.1 years, respectively). There was no gender-related differences with regard to the mean age of patients in all the diagnostic categories. CONCLUSIONS: This study provides baseline data on the age distribution of major upper gastrointestinal diseases among the Saudi population. The peculiarities of upper gastrointestinal endoscopic findings in advanced age are clarified. The influence of demographic changes on the pattern of these diseases in Saudi Arabia can be evaluated against our findings in the future.

Age Factors↗

PubMed1995

Changing demographics: past and future demands for early childhood programs.

This article provides a historical analysis of how demographic changes in the organization of American family life from the mid-1800s to the present have shaped the demand for programs to complement the efforts of families to educate and care for their children. The author asserts that the United States is in the midst of a second child care revolution. The first occurred in the late 1800s, when families left farming to enable fathers to take jobs in urban areas and when compulsory free public schooling was established for children age six and above. The second has developed over the past 55 years as the proportion of children under six living in families with two wage earners or a single working parent has escalated and propelled more and more young children into the early childhood care and education programs discussed throughout this journal issue. Looking to the future, the author sees indications that the demand for early childhood care and education programs will continue to grow while the needs of the children to be served will become increasingly diverse. To meet these dual pressures, the author argues that public funding for early childhood programs--like funding for public schools--is justified by the value such programs have for the broader society.

Adolescent↗

PubMed1995

[Women in the medical profession in Israel].

This paper describes the current status of women physicians in Israel at various stages in their professional careers: in medical school, in the medical specialties and in academia. In the past, as in most western countries, medicine in Israel was regarded as a man's profession. The last decade has seen major demographic changes: the proportion of women entering medical school is now similar to that of men, and as a result of immigration from the former Soviet Union, the percentage of women physicians is approaching the level in eastern European countries. Recent findings show an increase in women in all specialty areas. However, they are concentrated in the lower status strata and in primary care, occupying the base of the academic pyramid. It appears that when objective criteria are employed, such as for admission to medical school and licensing examinations, women and men have similar levels of achievement. However, when subjective criteria are used, such as in admission to residency training, gender-based differences in distribution in the medical specialties are apparent. We suggest implementing objective standards for acceptance for residency training which should help equalize the status of women in the Israeli medical establishment.

Emigration and Immigration↗

PubMedDate not supplied

Caring for the elderly: problems and priorities.

In view of the projected massive increase in the number of the very aged, all health-care agencies, professionals and the government must develop an acceptable strategy of care. With a positive attitude towards aging based on facts and knowledge, the burden of such a demographic change can be minimized. Perhaps a dedicated government department or even a separate ministry may be useful.

Aged↗

PubMed1996

Managed care in reconstructive pelvic surgery and urogynecology.

While demographic changes in future decades should expand the need for subspecialists in reconstructive pelvic surgery and urogynecology, managed care will probably limit access of patients to specialists in this field. Much of the evaluation and treatment for women with prolapse and incontinence will be provided by primary care providers.

Aged↗

PubMed1996

Hypertension control in developing countries: generic issues.

Epidemics of Cardiovascular Disease (CVD) are presently occuring or accelerating in developing countries, as epidemiologic transition accompanies socio-economic and demographic changes. Hypertension, a major risk factor for coronary and cerebrovascular disease, needs effective programmes for prevention, recognition and control. Strategically, hypertension control is ideally suited to be the initial component of an integrated CVD control programme which has to be implemented in the developing countries. Primary prevention, through a population based lifestyle linked programme, as well as cost-effective methods of detection and management are synergestically complementary approaches. The existing health care infrastructure needs to be reoriented to meet the emerging challenge of CVD, while empowering the community through health education.

Developing Countries↗

PubMedDate not supplied

[Retirement activities: wish or reality?].

The discrepancy between the potential and the reality of productive aging is very substantial. We have to deal with a structural gap. The individual productivity of aging is much more developed than the options of society for productive aging. Two ways of overcome the structural discrepancy are discussed. First options for post-retiremental activities are described. They follow the aim to enrich the role activities of elderly people by job options and honorary work. Second the model "Aktion 55" is discussed as an innovative initiative for new post-retirement activities. Future interventions have to follow demographic changes by developing age-integrated social roles and to leave age-differentiated activities and roles.

Activities of Daily Living↗

PubMed1996

[Coronary dilatation in geriatric patients--indications and results].

Therapy of coronary artery disease in elderly patients will gain in importance due to the demographic changes in industrialized societies. In our own institution 6.5% of all dilated patients were over 70 years of age in 1989, compared to 17.5% in 1995. Elderly patients were more likely to be women and to have unstable angina or multivessel disease. Primary success rates in elderly and younger patients are comparable. The current 3-year survival rate of 84 patients > or = 70 years of age is 92.9%. Long-term follow-up is primarily influenced by non-cardiac comorbidity. In conclusion, percutaneous transluminal coronary angioplasty (PTCA) results in a symptomatic improvement in elderly patients with single-vessel and most patients with multivessel disease.

Aged↗

PubMed1996

[Geography of effective size of rural populations of Northern Eurasia. Geographic correlation between effective size and level of heterozygosity of populations].

A significant geographical correlation (r = 0.719) was found between the logarithm of effective size (InNe) and heterozygosity level (H) in populations under the assumption of the Hardy-Weinberg equilibrium. The area of highest positive correlation was positioned meridionally between the Ob and Yenisei rivers, from the Arctic coast of Taimyr Peninsula to eastern Sayans and the southern Cis-Baikal region, i.e., in the same region where the highest distribution density of mean Ne values was found. Two additional areas of high correlations were found on the northern Black Sea coast and in the lower Lena river region. Analysis and mapping of correlation ratios eta H/lnNe2 and eta lnNe/H2 revealed that effective size substantially influenced heterozygosity level (as could be expected in the case of an intense gene drift), and heterozygosity level influenced effective size to the same extent. The latter relationship indicated an intense adaptation, and changes in diversity of the gene pool caused substantial demographic changes. However, this might be accounted for by direct gene migration into a population prevailing over reverse migration, i.e., mechanical population growth prevailing over natural growth.

Adaptation, Physiological↗

PubMedDate not supplied

Maternal-child health system and perinatal mortality in the United Arab Emirates.

The United Arab Emirates has witnessed extensive social and economic development during the past 2 decades. Significant demographic changes have also taken place mainly as a result of the continuous flow of expatriates. The development of the health care delivery system resulted in the reduction of the infant mortality rate by 25% (10.93 per thousand live births by 1992), but the perinatal mortality rate has remained almost unchanged. Although maternal and child health care has improved dramatically, its limited impact on perinatal mortality can be attributed to underutilization of maternal health centers, absence of screening programs for mothers at high risk, absence of regionalization of perinatal care centers, poor maternal and neonatal transport facilities, absence of effective referral and cooperation and interaction between hospitals and health centers, the limited number of nursing and medical staff, and, finally, underutilization of available information to support and enhance research. The national perinatal mortality survey may address and seek appropriate solutions to such problems.

Child Health Services↗

PubMed1996

The promise and practice of cardiovascular risk reduction: a disease management perspective. Clinical Quality Improvement Network (CQIN) Investigators.

OBJECTIVE: Interpretive analysis of epidemiological, clinical trials and practice pattern data for cardiovascular risk reduction in the contemporary setting of unprecedented demographic changes. DATA SOURCES: Literature review and audit results of the Clinical Quality Improvement Network (CQIN). DATA SYNTHESIS: Coronary artery disease (CAD) is the largest single cause of death in Canada. CAD is age-related and the population is rapidly ageing, a combination that threatens an epidemic of future CAD events. Epidemiological data demonstrate a direct relation of CAD risk and serum cholesterol levels and no threshold cholesterol level below which there is no CAD risk. The epidemiological data also suggest CAD risk can be reduced by lowering serum cholesterol and this hypothesis has now been incontrovertibly confirmed by repeated randomized clinical trials. Most recently, reduction of all-cause mortality with cholesterol-lowering therapy in high risk subjects has also been confirmed. Despite the overwhelming trials and epidemiological evidence, CQIN effectiveness analyses reveal far from optimal risk assessment and management practices among high risk patients. CONCLUSIONS: Serum cholesterol is directly related to CAD risk. Reduction of cholesterol reduces CAD, and all-cause, mortality in high risk patients. There is a large window of opportunity to improve lipid-lowering practices, and patient outcomes, for the most deadly diseases in our society.

Canada↗

PubMed1997

Genetic drift and gene flow in post-famine Ireland.

This study examines the genetic impact of the Great Famine (1846-1851) on the regional genetic structure of Ireland. The Great Famine resulted in a rapid decrease in population size throughout Ireland in a short period of time, increasing the possibility of genetic drift. Our study is based on migration and anthropometric data collected originally in the 1930s from 7211 adult Irish males. These data were subdivided into three time periods defined by year of birth: 1861-1880, 1881-1900, and 1901-1920. Within each time period the data were further subdivided into six geographic regions of Ireland. Estimates of Wright's FST were calculated from parent-offspring migration data and from 17 anthropometric variables (10 head measures, 7 body measures). Over time, the average population size decreased, but average rates of migration increased. The estimates of FST at equilibrium from migration matrix analysis suggest that the net effect of these opposite effects is a reduction in among-group variation. Closer examination shows that within each time period the rate of convergence to equilibrium is slow, meaning that the expected levels of genetic homogeneity revealed from migration matrix analysis are not likely to be seen over short intervals of time. Estimates of FST from anthropometric data show either relatively little change in microdifferentiation or some increase, depending on which variables are analyzed. Investigation of a simple model of demographic and genetic change shows that, given the demographic changes in post-Famine Ireland, FST could in theory increase, decrease, or remain the same over short intervals of time. Overall, the Great Famine appears to have had minimal impact on the genetic structure of Ireland on a regional level. Comparison with studies focusing on local genetic structure shows the opposite. It appears that the level of genetic impact depends strongly on the level of analysis; local populations are affected to a greater extent by demographic shifts than regional populations. We also provide formulas for the standard errors of FST from metric traits and related statistics.

Adolescent↗

PubMed1996

Intercountry adoption of Latin American children: the importance of early bilingual/bicultural services.

Because of major worldwide demographic changes, many Latin American children are frequently adopted in the U.S. This article presents an overview of the historical and contemporary circumstances and controversies surrounding intercountry adoptions (ICAs), and a review of possible risk factors for later child or adolescent maladjustment. Although a number of follow-up studies indicate a 70-80% positive outcome, some ICAs end in painful family-child disruptions. There is, therefore, a growing need for bilingual/bicultural mental health services to improve the initial adjustment process and to facilitate a positive long-term outcome. These services are especially needed when the child is older at arrival and the adopting family lives in a mostly homogeneous community. Suggested prearrival, arrival, and follow-up interventions with the family, the child, and the school are described. A case illustration of the interventions offered to a U.S. family and their recently adopted Latin American child is provided.

Adjustment Disorders↗

PubMed1997

A demographic approach to the assessment of Down syndrome screening performance.

The aim of this article is to examine the performance of screening for fetal Down syndrome (DS) in the context of demographic variation in time and place, using population and fertility data for several European countries. Two screening approaches are distinguished: one on the basis of maternal serum screening with human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) in combination with maternal age, and one on the basis of maternal age only. Screening performance, as measured by detection and false-positive ratios, is shown to be the result of the screening approach chosen and of the demographic characteristics of the population under consideration. A proper distinction between these two determinants of DS screening performance should be made, in order to distinguish between an improvement in screening performance that is brought about by a new screening approach and an improvement that is brought about by demographic change. We recommend that measures of DS screening performance be standardized for demographic variation. The methodology and demographic data presented in this article can be used for this purpose.

Adolescent↗

PubMed1997

Women & ageing.

Demographic changes have forced gerontologists to focus attention on the gender based character of population ageing. Ageing is likely to become a 'gender issue' with a large number of women surviving into very old age in almost all the countries of the world. Elderly women, especially in Third World countries like India, face several jeopardizes. They are likely to be illiterate or poorly educated, unlikely to be employed, most likely to be widowed and dependent on others, and they suffer from malnutrition and disabilitating symptoms as well as report higher psychological distress. The vulnerability of the ageing women, special types of problems they are likely to encounter over the life span, and factors that marginalise them need to be better understood. There is no clear awareness as yet, of the potential contribution of ageing women to the development process as ageing women are stereotypically perceived as burdens on the national economy. Strategies addressed to ensure health and well-being of older women need to be developed.

Aged↗