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PubMed2004

The importance of activities of daily living and social contact for loneliness: a survey among residents in nursing homes.

The aim of this study was to examine associations between functional ability to perform basic activities of daily living (ADL) functions (feeding, continence, going to the toilet, transferring from bed to chair, dressing and bathing), social contacts with family and friends/neighbours and emotional and social loneliness. A quantitative research approach, using a survey design, was performed. The sample comprised 113 subjects aged 65-101 years, living in nursing homes. Data were gathered through structured interviews by using the following measures: the modified Katz Index of ADL, the Revised Social Provisions Scale (SPS), and Family and Friendship Contacts Scale. Descriptive statistics, factor analyses, multiple correlation analyses and multiple regression analyses were used. Data showed a statistically significant relationship between dependence on the environment in carrying out ADL and low level of social loneliness. Likewise, high frequencies of social contact with sons, daughters and grandchildren had a statistically significant effect on low level of social loneliness. A confirmatory factor analysis (varimax rotation, eigenvalue 1.0) was employed to explore the two predefined dimensions (attachment and social integration) of the SPS. The results confirmed, to a very high degree, the two dimensions of the Weiss Model. Reliability (internal consistency), measured by Cronbach alpha, was 0.85 and 0.92, for attachment and social integration respectively. Based on this analysis, dependence in ADL function is important for a low level of social loneliness. From the present study it is concluded that ADL (feeding, continence, going to the toilet, transferring from bed to chair, dressing and bathing) and contact with a social network have a statistical effect on a low level of social loneliness. Hence, such associations may be of significance in nursing intervention and may influence the well-being of residents in nursing homes in different stages of life.

Activities of Daily Living↗
PubMed1986

A possible role for squalene in the pathogenesis of acne. I. In vitro study of squalene oxidation.

An in vitro study of the oxidation of squalene, and a description of factors acting on this transformation are presented. Thin layer chromatography was used to quantify the products generated by different oxidation processes. The results clearly show that squalene is a highly effective oxygen-scavenging agent. Its oxidation may first induce comedogenesis and, as a secondary event, cause a large reduction in oxygen tension in the human pilo-sebaceous duct. Porphyrins were confirmed to be highly efficient catalytic factors in the squalene oxidation process. The relationships between comedogenesis, bacterial colonization, and the role of sebum in the pathogenesis of acne are discussed in the light of these findings.

Acne Vulgaris↗
PubMed2000

Patterns of care in the early stages of Alzheimer's disease: impediments to timely diagnosis.

OBJECTIVE: Description of factors associated with delay in diagnosis of Alzheimer's disease (AD). DESIGN: A self-administered mail questionnaire. SETTING: Households including someone with AD identified through a nationwide marketing database. PARTICIPANTS: A total of 1480 caregivers of patients diagnosed with AD. MEASUREMENTS: There were two measures of delay examined through caregiver reports: (1) duration in years from first AD signs until determination of a definite problem, and (2) duration from problem recognition to first physician consultation. Also, caregivers were categorized by time since patient's diagnosis and relationship to patient. Within-group analyses examined the impact of these characteristics on delay measures. RESULTS: Mean lag in years from observation of first symptoms to problem recognition for those diagnosed in the past 12 months, the past 13 to 48 months, and the past 49 months or more was, respectively, 1.20, 1.56, and 2.25 (P < .001). The timing of diagnosis also influenced lag from problem recognition to first physician consultation so that subgroups with recent, less recent, and distant diagnosis reported delays in years of .82, .84, and 1.31 (P < .001). Caregiver relationship was not significantly related to these lags. Correct diagnosis of AD was reported by caregivers in only 38% of cases at initial physician consultation. CONCLUSIONS: These results suggest that both caregivers and physicians lack ready understanding of the difference between memory processes in aging and AD. Ongoing public and professional education is needed to convey the basics of the diagnosis of AD. In addition, routine screening for dementia should be considered to surmount attitudinal and logistical barriers.

Aging↗
PubMed1993

Nursing blood pressure research, 1980-1990: a bio-psycho-social perspective.

The purpose of this review is to examine nursing research on blood pressure (BP) from 1980 to 1990 from a bio-psycho-social perspective. Nursing research articles (N = 50) from three journals were reviewed. The inclusion of subject descriptions, environmental factors, dynamic and interpersonal aspects were tabulated. This review provides a basis for designing nursing research on BP with a broader perspective.

Adult↗
PubMed2006

Meningococcal meningitis prevention programs for college students: a review of the literature.

BACKGROUND AND PURPOSE: The incidence of meningococcal meningitis in college students is higher than in other populations. College students, especially 1st-year students living in dormitories or residence halls, are among those at highest risk of developing the disease. It is estimated that immunization can prevent up to 83% of cases among adolescents and college students. A review of the literature was undertaken to identify and critique the research-based prevention programs that are focused on college students. METHOD: An extensive search of the Cochrane Database of systematic reviews, Medline, PubMed, and CINAHL was undertaken. The Journal of American College Health was hand searched, and bibliographies were reviewed for studies not otherwise identified. Four publications met the search criteria. These studies were reviewed and graded for level of evidence. FINDINGS: One study could not be compared with the other three because of its lack of detail. Of the other three studies, two were descriptive and factors were identified that related to vaccination and nonvaccination in the college student population (both Evidence Grade C). Only one study was described that included an educational intervention, which resulted in increased vaccination rates in a college student population (Evidence Grade B). CONCLUSIONS AND IMPLICATIONS: The published literature is severely limited in the area of meningococcal meningitis prevention programs in the at-risk college student population. A critical need exists for controlled studies to test the interventions that are most effective in this population as well as broader-based studies to further identify those students at increased risk for the disease as well as for nonvaccination.

Adolescent↗
PubMed1993

Social epidemiology of chickenpox in two British national cohorts.

STUDY OBJECTIVE: To provide a quantitative description of factors independently predictive of reported chickenpox infections in two national cohorts of British children. DESIGN: Longitudinal cohort study design employing logistic regression analysis of data obtained in the 1970 British Births Survey (later to become the Child Health and Education Study, CHES), and the 1958 British Perinatal Mortality Survey (later to become the National Child Development Survey, NCDS). SETTINGS: One-week birth cohorts covering the whole of the United Kingdom. PARTICIPANTS: Data were obtained from questionnaires administered to the carers of 10,196 children born in the UK between 5 and 11 April 1970 (CHES) and 10,927 children born in the UK between 3 and 9 March 1958 (NCDS). These numbers consist of the whole of the surviving cohorts excluding those for whom data were incomplete. MEASUREMENTS: Biological, social, and medical factors in the parents and children, as recorded by the child's principle carer or from clinical notes. MAIN RESULTS: Chickenpox by the age of 10 years was reported to be more common in the children of advantaged families (higher social class, higher parental education levels), with a higher prevalence in those parts of the United Kingdom normally associated with affluence, such as the South East and South West of England, and lower rates in Wales and Scotland. Chickenpox by 10 years was also associated with more crowding in the home. A similar but less marked pattern occurred for chickenpox by the age of 11 years in the 1958 NCDS cohort. This social distribution apparently reflected overall rather than age-specific susceptibility. CONCLUSIONS: The national and international pattern of chickenpox epidemiology indicate that both social and climatological factors may be important in defining groups at risk. Further research is indicated if a vaccination service is to be implemented in this country.

Age Factors↗
PubMed1986

Resonant amplification of delivered volume during high-frequency ventilation.

The volume of gas delivered from a high-frequency ventilation (HFV) circuit was measured with an ultrasonic flowmeter. The measurements were done in vitro (20-liter air-filled glass bottle) and in vivo (9 anesthetized dogs lying supine) at oscillation frequencies ranging from 4 to 23 Hz and stroke volumes of the pump ranging from 36 to 150 ml. We varied the length and diameter of the tube connecting the pump with the endotracheal tube, the length and diameter of the bias outflow tube, the diameter of the endotracheal tube, and the stroke volume of the pump. Both in vitro and in vivo, there was resonant amplification of the delivered gas volume; i.e., the delivered gas volume exceeded the stroke volume at certain frequencies. Altering the dimensions of connecting tube, endotracheal tube, bias outflow tube, or stroke volume, i.e., changing the resistance to gas flow, gas compliance, and/or gas inertance in these elements, altered the ratio of gas delivered to stroke volume that could be predicted by an electric analog. These data indicate that the delivered gas volume during HFV depends critically on the configuration of the HFV circuit, the size of the endotracheal tube, the oscillation frequency, and the pump stroke volume. Knowledge of the delivered gas volume during HFV and appreciation of the phenomenon of resonant amplification of the delivered gas volume will permit a more accurate description of factors contributing to gas transport during HFV.

Animals↗
PubMed2006

[The patient's right to information: influence of socio-professional factors in primary care].

OBJECTIVES: To describe the information provided by primary care doctors to their patients in different phases of the care provision process and to analyse any relationships with socio-professional factors. DESIGN: Descriptive, cross-sectional study based on postal questionnaire. SETTING: Primary care centres in Murcia, Spain. PARTICIPANTS: 227 family physicians. INTERVENTIONS: Distribution of a questionnaire which includes: a) socio-professional variables (age, sex, marital status, years in practice, years in present post, work environment, previous training, number of patients on list, number of patients seen daily); b) an evaluation of job satisfaction (Likert scale) related to salary, career choice, immediate superiors and daily surgery; and c) the frequency with which information is provided to patients concerning diagnosis, prognosis, treatment, complementary examinations and personal, professional and family impact. MAIN MEASUREMENTS AND RESULTS: The reply rate was 59%. The percentages of doctors who always provided information concerning diagnosis, prognosis, treatment, complementary examinations and person, professional and family impact was, 23.3%, 7%, 64.3%, 40.5%, and 9.7%, respectively. There was a direct and statistically significant relationship between job satisfaction and the information provided to patients, the doctors feeling most satisfaction providing the most information on the different phases of the care process. On the other hand, there was an inverse and statistically significant relationship between the number of patients on the doctors' lists and the information provided. CONCLUSIONS: The degree of fulfillment of the patient's right to information is low. Doctors should realise the practical importance of clinical information in their work. There is a general feeling of discontent amongst family doctors, which has a negative impact on their professional activity. A lighter workload would significantly improve the extent to which doctors provide patients with information and mechanisms should be put in place to improve working conditions to avoid the non-fulfillment of the patient's right to information.

Adult↗
PubMed2001

Topography of cerebral white-matter disease of prematurity studied prospectively in 1607 very-low-birthweight infants.

The objective of this study was to evaluate to what extent (1) the characteristics of localization, distribution, and size of echodense and echolucent abnormalities enable individuals to be designated as having either periventricular hemorrhagic infarction or periventricular leukomalacia and (2) the characteristics of periventricular hemorrhagic infarction and periventricular leukomalacia are independent occurrences. The population for this study consisted of 1607 infants with birthweights of 500 to 1500 g, born between January 1991 and December 1993, who had at least one cranial ultrasound scan read independently by at least two ultrasonographers. The ultrasound data collection form diagrammed six standard coronal views. The cerebrum was divided into 17 zones in each hemisphere. All abnormalities were described as being echodense or echolucent and were classified on the basis of their size, laterality, location, and evolution. Eight percent (134/1607) of infants had at least one white-matter abnormality. The prevalence of white-matter disease decreased with increasing gestational age. Most abnormalities were small or medium sized and unilateral; only large echodensities tended to be bilateral and asymmetric. Large abnormalities, whether echodense or echolucent, were more likely than smaller abnormalities to be widespread, and the extent of cerebral involvement was independent of whether abnormalities were unilateral or bilateral. Large abnormalities were relatively more likely than small abnormalities to involve anterior planes. Small abnormalities, whether echodense or echolucent, or whether unilateral or bilateral, preferentially occurred near the trigone. Using the characteristics of location, size, and laterality/symmetry, we were able to allocate only 53% of infants with white-matter abnormalities to periventricular hemorrhagic infarction or periventricular leukomalacia. Assuming that periventricular leukomalacia and periventricular hemorrhagic infarction are independent and do not share risk factors, and that each occurs in approximately 5% of infants, we would have expected 0.25%, or about 4 individuals, to have abnormalities with characteristics of both periventricular leukomalacia and periventricular hemorrhagic infarction, whereas we found 63 such infants. Most infants with white-matter disease could not be clearly designated as having periventricular hemorrhagic infarction or periventricular leukomalacia only. Periventricular hemorrhagic infarction contributes to the risk of periventricular leukomalacia occurrence, or the two sorts of abnormalities share common risk antecedent factors. The descriptive term echodense or echolucent and the generic term white-matter disease of prematurity should be used instead of periventricular leukomalacia or periventricular hemorrhagic infarction when referring to sonographically defined white-matter abnormalities.

Brain Mapping↗
PubMed2004

Development and testing of a new instrument for measuring concerns about dying in health care providers.

A new measure of concerns about dying was investigated in this psychometric study. The Concerns About Dying instrument (CAD) was administered to medical students, nursing students, hospice nurses, and life sciences graduate students (N = 207) on two occasions; on one occasion they also completed three related measures. Analyses included descriptive statistics, factor analysis, Cronbach's alpha, test-retest correlations, t tests, and correlations with other measures. Results suggest the CAD measures three distinct but related areas: general concern about death, spirituality, and patient-related concern about death. Reliability estimates were good, and correlations with related measures were strong. Between-group differences suggest scores are related to actual differences in level of concern and beliefs about death and dying. The CAD has the advantage of being very brief and of explicitly assessing concerns about working with patients who are dying.

Adult↗
PubMedDate not supplied

Children's health insurance, access to care, and health status: new findings.

Despite various policy initiatives, a substantial number of children in the United States remain uninsured, have problems with access to health care, or are in fair or poor health. These difficulties are not evenly distributed across the population. Hispanic children, those whose parents have little education, and those who live in families without an employed parent are at disproportionately high risk of encountering these problems. Although multivariate analyses would be required to disentangle the complex relationships among these factors, these descriptive data reveal the segments of the population to which new health-related programs, such as CHIP-funded state plans, might most productively be directed. Issues concerning children's health are likely to remain on the national policy agenda for some time to come. Because MEPS is a continuing data collection effort, it will enable researchers and policymakers to follow trends in these issues over time. For example, MEPS data will support evaluations at the national level to determine whether children who lack health insurance or a usual source of care will actually face fewer barriers after CHIP-funded programs are implemented. This paper provides a baseline against which to evaluate the impact of CHIP and other policy changes on the health and well-being of America's children.

Adolescent↗
PubMed2006

Reduction in neonatal mortality in Chile between 1990 and 2000.

OBJECTIVE: Our objective with this article was to describe the declining trend in neonatal mortality in Chile between 1990 and 2000 and examine potential causal factors. METHODS: Descriptive analysis of data that were provided by the Chilean Ministry of Health on all approximately 2,900,000 births occurred in Chile between 1990 and 2000. Total neonatal mortality rates (<28 days), and birth weight-specific and gestational age-specific mortality rates from 1990 to 2000 were analyzed by year. Public health interventions that were implemented during the 1990s were reviewed to assess their potential influence on the observed trends in neonatal mortality. RESULTS: The neonatal mortality rate between 1990 and 2000 decreased from 8.3 to 5.7 per 1000 live births. This decline was not associated with decreases in the proportion of low birth weight and preterm infants but rather with declines in birth weight-specific and gestational age-specific mortality rates. Examination of the trends in birth weight-specific and gestational age-specific mortality rates showed that a marked proportional decrease in mortality rates was achieved among infants who weighed <1500 g and were delivered before 32 weeks. It is plausible, both biologically and temporally, that the observed trends in the reduction in birth weight-specific and gestational age-specific mortality rates are associated with the introduction of specific sector-wide interventions that aim to improve newborn care in very preterm and low birth weight infants. CONCLUSIONS: Important reductions in newborn mortality in developing countries are possible with the implementation of effective neonatal care interventions.

Birth Weight↗
PubMed1981

Mistreatment of the elderly in the domestic setting: an exploratory study.

Professionals and practitioners (N = 228) involved in providing services to the elderly were interviewed regarding their experiences with the mistreatment of older people by their families. Semi-structured questions dealt with: case identification and follow-up procedures; perceptions of etiological factors; and descriptive typologies from illustrative case histories. Findings indicated that domestic mistreatment of the elderly was familiar to most professionals interviewed, to the extent that 60 per cent of the respondents dealt with such cases on a weekly basis. Among the 10 professional groups interviewed, there was little variation in their experiences with neglect; police officers, lawyers, community mental health and aging services workers had greater exposure to cases of physical abuse. Intentional mistreatment was typically viewed as a consequence of inadequacies in the caretaker, while unintentional cases were related to the victims' isolation. Most respondents indicated that there were no established procedures for dealing with, or following-up mistreatment cases, and over one-half reported that nothing was done. Differences in perception of the etiology of domestic mistreatment of the elderly were closely related to the occupational perspectives of the various respondent groups. Although incidence rates could not be established, 89 illustrative cases of domestic mistreatment of the elderly were indicative of the severity of the occurrences and the absence of appropriate interventions.

Aged↗
PubMed2006

[The substitution effect of leadership substitutes for transformational leadership in nursing organization].

PURPOSE: This paper was conducted to examine the effects of transformational leadership behaviors, within the substitutes for leadership model (Kerr & Jermier, 1978). METHOD: Data was collected from 181 staff nurses in 3 general hospitals, with self-reporting questionnaires (MLQ developed by Bass, rd-SLS developed by Podsakoff, et al., and MSQ developed by Weiss, et al.). Descriptive statistics, factor analysis, Cronbach's alpha and moderated regression analysis were used. RESULT: 1) The transformational leader behaviors and substitutes for leadership each had correlations with job satisfaction. 2) The total amount of variance accounted for by the substitutes for leadership was substantially greater than by the transformational leadership behaviors. 3) Few of the substitutes variables moderated the relationships between the transformational leader behaviors and job satisfaction in a manner consistent with that specified by Howell, Dorfman, and Kerr (1986). CONCLUSION: The finding of this study suggest that leaders need to have a better understanding of those contextual variables that influence job satisfaction. Thus future research should focus attention on the moderating effects of substitutes, as well as the things that leaders can do to influence them. In addition, it may be good to examine the effects of substitutes on other criterion variables.

Adult↗
PubMed1999

[The prevalence of urinary incontinence in a population over 60 treated in primary care].

OBJECTIVES: To determine the prevalence of urine incontinence (UI) among the over-60 population treated in primary care, identifying the types and associated epidemiological factors. DESIGN: Descriptive and crossover. SETTING: Primary care. PATIENTS: Sample of 400 people aged 60 or over, stratified by sex and chosen from those who attended their health centre spontaneously for a consultation. MEASUREMENTS AND RESULTS: Age, sex, chronic illnesses, treatments, previous childbirths, grade of immobility and presence or absence of involuntary discharge of urine. If the reply was positive: frequency, characteristics and evolution of UI, and prior consultations on the problem were also measured. 400 people (254 women and 146 men). Mean age: 71 (SD = 7.3 years). 145 people (36.2%) recognised they had UI. 43.3% of women and 23.9% of men (p < 0.001) were incontinent. UI prevalence increased with age: 31.7% among the 60-69 year old group; 35% among the 70-79 group; and 53.3% in those over 80. Among women the most common types are stress and urge incontinence, whereas among men the most common are urge and overflow UI. UI prevalence is greater among women with previous childbirths and among immobile patients. Of the 145 people who recognised their UI, only 31 (21.3%) had previously consulted the doctor on this problem, although men had consulted significantly more than women (40% vs. 15.4%; p < 0.01). CONCLUSIONS: Over a third of the people over 60 in our clinics suffer from UI. Prevalence increases with age and is greater among women, especially if there is a history of childbirth. Urge UI predominates among men and stress UI among women. Most people with UI do not consult concerning their problem, for which reason, so as to identify it and adopt corrective measures, women especially must be systematically asked about the symptom.

Age Distribution↗
PubMed2002

Public perceptions of cerebral palsy.

Neurologic disorders are often described in terms that relate to symptoms rather than specific etiologic factors. Such descriptive terms are confusing to healthcare professionals and to the parents of children in whom these disorders are diagnosed. Cerebral palsy is one example of a descriptive term that is applied to a disorder that is heterogeneous in its etiology, morbidity, and mortality. A random sampling of 100 adults selected from the waiting room of a suburban ambulatory pediatrics office associated with the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine (Stratford, NJ) was surveyed with a 20-item questionnaire on their perceptions of the term cerebral palsy and its associated disability and prognosis. Subjects' responses suggest that a percentage of the general population holds several misconceptions about the disorder, including the belief that the disorder has a genetic etiology (40%) and that affected children cannot speak (20%), die earlier than unaffected children (57%), and cannot hold jobs as adults (20%) should they survive to adulthood. A small percentage of subjects believe that cerebral palsy is infectious (4%) and that parents should restrict their children from associating with those affected (3%). Our study population was somewhat homogenous in that most respondents were educated and most were middle to upper-middle class. Yet, even in this population, the term cerebral palsy is ambiguous to many and may have negative connotations. Further studies are needed to address whether a higher frequency of negative perceptions are present in more socioeconomically diverse populations.

Adult↗
PubMed2005

The influence of academic projects on the professional socialization of family medicine faculty.

BACKGROUND: Successful academic physicians acquire and maintain productive colleague relationships, understand unwritten rules of academe, and effectively manage their careers. Developing these professional socialization skills are goals of some faculty development programs (FDPs), but there is scant evidence about whether such programs are effective. METHODS: A nationwide retrospective, cross-sectional written survey was conducted in two phases: (1) FDP directors who received US Department of Health and Human Services, Health Resources and Services Administration support between 1994 and 1997 described program activities and provided enrollee rosters and (2) enrollees reported socialization and colleague outcomes. Instruments were developed, pilot tested, and administered for this study. Analysis utilized descriptive statistics, factor analysis, and ANOVA. RESULTS: Of 52 eligible directors, 37 (71%) provided FDP activity details and rosters. Of 543 eligible enrollees, 351 (65%) returned surveys. A key result of factor analysis was a seven-item scale related to academic project activities. FDPs with greater emphasis on these activities were associated with enrollees reporting higher levels of colleague relationships and professional socialization skills. CONCLUSION: This study's factor analysis indicates that certain FDP project activities are positively associated with enrollees' professional socialization outcomes.

Adult↗