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PubMed1996

Sexual adjustment and quality of relationship in spinal paraplegia: a controlled study.

OBJECTIVE: To identify determinants of sexual adjustment by persons with spinal cord injury (SCI) and quality of the relationship compared with persons in the general population. DESIGN: Controlled survey. SETTING: Postdischarge community setting. PARTICIPANTS: A consecutive series of 252 persons admitted to our spinal unit between November 1982 and July 1991 with traumatic SCI were contacted, 85 of whom persons were excluded: 36 were dead, 37 had recovered, 5 could not be located, 4 were younger than 18 years, 2 had language difficulties, and 1 had a psychiatric illness. Of the remaining 167 persons with SCI, 85 had a stable partner relationship, 75 of whom (88%) completed and returned the questionnaires (median age, 33 years; range 19 to 76). An age- and sex-matched control group was randomly selected from the general population. Of the 264 respondents, 155 (59%) had a stable partner relationship. MAIN OUTCOME MEASURES: The 80-item questionnaire addressed experiences concerning sexual functioning, desire, and activity, sexual behavior, satisfaction with sex life, and aspects of the emotional quality of the relationship. RESULTS: Sexual activity and satisfaction was lower among persons with SCI compared with the controls; the emotional quality of the relationship did not differ. The most important correlates for sexual fulfillment in both groups were found to be the use of a varied repertoire of sexual behaviors and the perception that the partner enjoys and is satisfied with the sexual part of the relationship. CONCLUSION: Psychosocial rather than physical factors were important for a satisfying sexual life and relationship. A qualitative study should be undertaken to further explore the complexity of sexual adjustment after SCI.

Adaptation, Psychological↗

PubMed2002

Benzodiazepine use and risk of dementia: a nested case-control study.

The objective of this article was to examine the possible association between benzodiazepine use and the risk of dementia in the elderly. This was a nested case--control study set in community settings in Bordeaux area, France. The participants were a representative sample of 3,777 elderly persons (65 years of age and older) followed from 1989 to 1997. The main outcome measures were the use of benzodiazepines in incident cases of dementia versus nondemented controls. On the basis of medical and psychological data, 150 patients were diagnosed with dementia according to the criteria of the third revision of the Diagnostic and Statistical Manual of Mental Disorders. Information on benzodiazepine use was obtained by face-to-face interview and visual assessment of patient's medicine chest by a trained neuropsychologist. After controlling for age, gender, education level, living alone, wine consumption, psychiatric history, and depressive symptomatology, ever use of benzodiazepines was associated with a significantly increased risk of dementia [adjusted odds ratio (OR), 1.7; 95% confidence interval, 1.2-2.4]. Former use was associated with a significantly increased risk of dementia (adjusted OR, 2.3; 95% CI,1.2-4.5). No association was found between dementia and the current use of benzodiazepines (adjusted OR, 1.0; 95% CI, 0.6-1.6). Our finding suggest that former use of benzodiazepines could be a risk factor for dementia, but more detailed investigation are needed.

Aged↗

PubMed2006

"There's no point in complaining, nothing changes": rural disaffection with complaints as an improvement method.

OBJECTIVE: To validate earlier findings that lack of access to health services is the most likely issue of complaint by rural consumers, and that lack of knowledge about how to make effective complaints and scepticism that responses to complaints bring about service improvement account for the under-representation of complaints from rural consumers. DESIGN: Unaddressed reply-paid mail survey to 100% of households in small communities, and 50%, 20% or 10% in progressively larger communities. SETTING: Eight communities in the Loddon-Mallee region of Victoria. PARTICIPANTS: 983 householders most responsible for the health care of household members, responding to a mailed questionnaire. MAIN OUTCOME MEASURES: Issues of complaints actually made; issues of unsatisfactory situations when a complaint was not made; reasons for not complaining; to whom complaints are made; and plans for dealing with any future complaint. RESULTS: Earlier findings were confirmed. Lack of access to health services was the most important issue, indicated by 54.8% of those who had made a complaint, and 72% of those who wanted to but did not. The most common reason given for not complaining was that it was futile to do so. Lack of knowledge of how to make effective complaints which might contribute to the quality assurance cycle was evident. CONCLUSIONS: Rural consumers' disaffection with health complaints as a means to quality improvement poses a significant barrier to consumer engagement in quality assurance processes. Provider practices may need to change to regain community confidence in quality improvement processes.

Adolescent↗

PubMed1999

Results of intertrochanteric femur fractures treated with a 135-degree sliding screw with a two-hole side plate.

OBJECTIVE: To observe and report the clinical results of the treatment of intertrochanteric hip fractures treated with a 135-degree hip screw with a two-hole side plate. DESIGN: Prospective consecutive. SETTING: Community private practice. PATIENTS: A consecutive series of seventy primarily older patients with intertrochanteric hip fractures treated in a community hospital setting. INTERVENTION: Surgical treatment with a 135-degree sliding hip screw and a two-hole side plate. MAIN OUTCOME MEASUREMENTS: Healing rate and time, operative blood loss and time, incidence of hardware failure, and complications including loss of side plate fixation and amount of collapse. RESULTS: Sixty-nine patients, with seventy intertrochanteric hip fractures, underwent surgical treatment with a 135-degree sliding hip screw and a two-hole side plate. There were twenty-one (30 percent) A1.1, sixteen (23 percent) A1.2, twenty-one (30 percent) A2.1, and twelve (17 percent) A2.2 fractures in twenty-three (33 percent) men and forty-six (67 percent) women. Average age was seventy-nine years. The average estimated blood loss was seventy-seven cubic centimeters (range 10 to 300 cubic centimeters), and the average surgical time was thirty-one minutes (range 8 to 90 minutes). The average time to union was fifteen weeks (range 8 to 17 weeks). There were three failures: two from screw cut-out and one from screw plate dissociation. No cases failed due to loss of fixation of the two-hole side plate. Collapse was minimum in fifty-five patients (79 percent), moderate in twelve patients (17 percent), and severe in two patients (3 percent). CONCLUSIONS: Use of the 135-degree sliding hip screw with a two-hole side plate produces satisfactory healing and results in relatively low blood loss and short surgical times without the loss of side plate fixation.

Aged↗

PubMed2005

Mobility limitations in the Medicare population: prevalence and sociodemographic and clinical correlates.

OBJECTIVES: To examine the prevalence of and clinical markers associated with mobility limitations in Medicare Current Beneficiary Community Survey (MCBS) respondents. DESIGN: Cross-sectional analysis of a community survey. SETTING: Community. PARTICIPANTS: Twelve thousand seven hundred sixty-nine respondents from the 2001 MCBS, aged 65 and older. MEASUREMENTS: Four questions from the MCBS were used to create four levels of mobility limitation: none, mild, moderate, and severe. Sampling weights were used to calculate estimates of means and proportions of the entire Medicare population for each mobility limitation category. A polytomous logistic regression analysis was used to model the association between four levels of mobility limitation and sociodemographic and clinical variables. RESULTS: Prevalence of mobility limitations ranged from 9.5 million (mild) to 1.2 million (severe). Increasing severity of mobility limitation was associated with older age, being female, reporting fair or poor health, being overweight, smoking, having a greater number of comorbidities, having an annual income below $25,000, having less than a high school education, being unmarried, and living with others. CONCLUSION: National prevalence estimates suggest that functional mobility limitation is a significant problem for many older adults and is associated with some potentially modifiable characteristics.

Activities of Daily Living↗

PubMed1995

Is community screening for amblyopia possible, or appropriate?

Photoscreeners are becoming increasingly available and are being widely used to screen for visual abnormalities in young children. However, consideration of accepted criteria for screening programs indicates there is still much further research that needs to be carried out before amblyopia screening could be recommended as a routine component of a community health surveillance program--an adequate description of the potential consequences of an individual developing amblyopia has yet to be provided and the natural history of the condition and factors that determine the effectiveness of treatment have yet to be fully described. While there is the promise of technology that satisfies specific test requirements, this still needs to be trialed in community settings and community trials are required before it will be possible to determine whether the costs that will be incurred in carrying out routine screening and in providing the resources for treatment are warranted. In conclusion, the development of new and possibly more effective technology for screening is only part of the answer to the amblyopia question. While superficially this technology makes screening for amblyopia a possibility, we do not know at this stage whether or not it is appropriate.

Amblyopia↗

PubMed1995

Social cost of land mines in four countries: Afghanistan, Bosnia, Cambodia, and Mozambique.

OBJECTIVES: To document the effects of land mines on the health and social conditions of communities in four affected countries. DESIGN: A cross design of cluster survey and rapid appraisal methods including a household questionnaire and qualitative data from key informants, institutional reviews, and focus groups of survivors of land mines from the same communities. SETTING: 206 communities, 37 in Afghanistan, 66 in Bosnia, 38 in Cambodia, and 65 in Mozambique. SUBJECTS: 174,489 people living in 32,904 households in the selected communities. MAIN OUTCOME MEASURES: Effects of land mines on food security, residence, livestock, and land use; risk factors: extent of individual land mine injuries; physical, psychological, social, and economic costs of injuries during medical care and rehabilitation. RESULTS: Between 25% and 87% of households had daily activities affected by land mines. Based on expected production without the mines, agricultural production could increase by 88-200% in different regions of Afghanistan, 11% in Bosnia, 135% in Cambodia, and 3.6% in Mozambique. A total of 54,554 animals was lost because of land mines, with a minimum cash value of $6.5m, or nearly $200 per household. Overall, 6% of households (1964) reported a land mine victim; a third of victims died in the blast. One in 10 of the victims was a child. The most frequent activities associated with land mine incidents were agricultural or pastoral, except in Bosnia where more than half resulted from military activities, usually during patrols. Incidences have more than doubled between 1980-3 and 1990-3, excluding the incidents in Bosnia. Some 22% of victims (455/2100) were from households reporting attempts to remove land mines; in these households there was a greatly increased risk of injury (odds ratio 4.2 and risk difference 19% across the four countries). Lethality of the mines varied; in Bosnia each blast killed an average of 0.54 people and injured 1.4, whereas in Mozambique each blast killed 1.45 people and wounded 1.27. Households with a land mine victim were 40% more likely to experience difficulty in providing food for the family. Family relationships were affected for around one in every four victims and relationships with colleagues in 40%. CONCLUSIONS: Land mines seriously undermine the economy and food security in affected countries; they kill and maim civilians at an increasing rate. The expense of medical care and rehabilitation add economic disability to the physical burden. Awareness of land mines can be targeted at high risk attitudes, such as those associated with tampering with mines.

Adolescent↗

PubMedDate not supplied

Patient evaluations of pharmacist performance with variations in attire and communication levels.

OBJECTIVE: To determine whether the attire of a pharmacist has any effect on how he is evaluated when a patient also considers the pharmacist's performance and to assess whether attire and performance interact to influence patients' evaluations. DESIGN: Randomized, cross-sectional, three-factor design. SETTING: Community pharmacy settings were portrayed. PARTICIPANTS: 179 university staff members. INTERVENTIONS: Videos of pharmacist-patient interactions were encoded and placed on a Web site to be viewed by participants. MAIN OUTCOME MEASURES: Service encounter satisfaction, perceptions of overall service quality, trust in the service provider, and behavioral intentions based on two levels of pharmacist communication performance (high or adequate), three levels of dress style (casual, business casual, formal), and two levels of white coat (wearing or not). RESULTS: Of the three independent variables, only communication performance was found to significantly influence the dependent variables. High communication performance resulted in higher satisfaction scores, higher perceptions of quality, higher levels of trust, and behavioral intention scores that reflected a greater willingness to use and recommend the pharmacist. CONCLUSION: Style of dress or whether the pharmacist was wearing a white coat did not significantly influence participants' evaluations of the pharmacist in this study. Rather, the level of the pharmacist's communication performance was the most important cue used by participants in their ratings of service encounter satisfaction, perceptions of overall service quality, and trust in the service provider.

Adult↗

PubMed2005

Senior care clerkship: an innovative collaboration of pharmaceutical care and learning.

OBJECTIVE: To describe an advanced senior care practice experience (clerkship) that provides geriatric specialty training and outreach services. SETTING: Assisted living facility (ALF) and an adjoining medical clinic. PRACTICE DESCRIPTION: This report describes an experiential training program for doctor of pharmacy students taking place in a multidisciplinary setting involving a multiethnic population. PRACTICE INNOVATION: Students participate in activities in three settings--ALF, community, and ambulatory clinic. In the ALF, students conduct medication regimen review and provide recommendations in medication therapy, administer influenza vaccinations and participate in staff education. Clinic-based training includes anticoagulation, asthma, and diabetes management. Community outreach activities include hypertension monitoring, brown-bag medication reviews, and home visits. MAIN OUTCOME MEASUREMENTS: Documentation of students' participation and pharmaceutical care activities included the number of letters, and the number and types of medication recommendations sent to the providers, the providers' response to these recommendations, the changes in immunization rates, and number of older adults who received care from the students. RESULTS: Twenty-four students completed the clerkship over three years. They sent 154 letters to 50 physicians with 287 recommendations involving the care of 118 ALF residents and improved the average annual vaccination rate in the ALF to 68%, compared with zero before student involvement. In the clinic, students provided services to 125 patients under a preceptor's supervision during a 30-month period. In the community setting, a weekly average of 35 elders participated in student-conducted pharmaceutical activities. CONCLUSION: Overall, the clerkship was a successful collaboration of learning and provision of care. The students were successful in improving the medication therapy of senior adults in the three settings.

Journal Article↗

PubMed1995

Sustainability of a successful health and nutrition program in a remote aboriginal community.

OBJECTIVE: To assess the long term effect of a nutrition program in a remote Aboriginal community (Minjilang). DESIGN: Evaluation of nutritional outcomes over the three years before and the three years after a health and nutrition program that ran from June 1989 to June 1990. Turnover of food items at the community store was used as a measure of dietary intake at Minjilang and a comparison community. SETTING: A community of about 150 Aboriginal people live at Minjilang on Croker Island, 240 km north-east of Darwin. A similar community of about 300 people on another island was used as the comparison. RESULTS: The program produced lasting improvements in dietary intake of most target foods (including fruit, vegetables and wholegrain bread) and nutrients (including folate, ascorbic acid and thiamine). Sugar intake fell in both communities before the program, but the additional decrease in sugar consumption during the program at Minjilang "rebounded" in the next year. Dietary improvements in the comparison community were delayed and smaller than at Minjilang. CONCLUSIONS: The success of the program at Minjilang was linked to an ongoing process of social change, which in turn provided a stimulus for dietary improvement in the comparison community. When Aboriginal people themselves control and maintain ownership of community-based intervention programs, nutritional improvements can be initiated and sustained.

Diet↗

PubMedDate not supplied

A community-based program for cardiovascular health awareness.

OBJECTIVE: The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults. PARTICIPANTS: Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations. SETTING: Community pharmacies and family physician offices. INTERVENTION: CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP. OUTCOMES: Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists. CONCLUSION: The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.

Attitude of Health Personnel↗

PubMed1994

Protection against hepatitis A by an inactivated vaccine.

OBJECTIVE: To evaluate the safety and efficacy of a new inactivated hepatitis A vaccine. DESIGN: Double-blind randomized controlled trial stratified by community. SETTING: Community-based in Thailand. STUDY PARTICIPANTS: A total of 40,119 children, aged 1 to 16 years, attending 148 primary schools: 38,157 (95%) entered surveillance a mean of 138 days after receiving vaccine dose 1; 33,586 (84%) completed the controlled trial of 532 days; and 31,075 (81%) received crossover vaccine and remained under surveillance until day 844. INTERVENTION: Participants received hepatitis A vaccine or control hepatitis B vaccine starting January 7, 1991 (doses in months 0, 1, and 12), and crossed over to the alternate vaccine 18 months later. MAIN OUTCOME MEASURE: Cases of hepatitis A (symptoms, alanine aminotransferase levels of 45 U/L or higher, and IgM to hepatitis A virus) were identified by evaluating school absences of 2 or more days. RESULTS: There were no serious adverse reactions despite administration of more than 109,000 doses of hepatitis A vaccine. Among initially seronegative recipients of two doses of hepatitis A vaccine, the proportion with 20 mIU/mL or more of antibody to hepatitis A virus before and 5 months after a 1-year booster was 94% and 99%, respectively. Of 6976 episodes of illness during the controlled trial, there were 40 cases of hepatitis A; 38 were in the control group. Of the 40 cases, six, all in controls, occurred after the 1-year booster dose. Following two doses of hepatitis A vaccine (days 138 through 386), protective efficacy was 94% (95% confidence interval, 79% to 99%); cumulative efficacy including the postbooster period (days 138 to 532) was 95% (95% confidence interval, 82% to 99%). The two hepatitis A vaccine recipients who had symptomatic infections (257 and 267 days after dose 1) appeared to have been partially protected since their illnesses were brief and associated with only slight increases in alanine aminotransferase. CONCLUSIONS: Inactivated hepatitis A vaccine is safe; when administered in two doses, it protects against hepatitis A for at least 1 year.

Adolescent↗

PubMedDate not supplied

Changes in bone density with lactation.

OBJECTIVE: To test the a priori hypotheses that significant bone loss occurs in lactation of greater than 5 months' duration and that bone mass returns to baseline levels when breast-feeding ceases. DESIGN: Prospective cohort study design of 12 months' duration. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 98 healthy women of white (n = 95) and Asian (n = 3) origin, aged 20 to 40 years, and 0 to 1 parity prior to parturition, grouped according to lactation duration: 0 through 1, 2 through 5, and 6 or more months. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the proximal femur was measured by dual-energy x-ray densitometry at 2 weeks (baseline), 2 months, 4 months, 6 months, and 12 months following parturition, and BMD of the lumbar spine was measured at baseline, 6 months, and 12 months after parturition. RESULTS: Women with lactation duration of 6 months or longer had mean BMD losses of 5.1% and 4.8% at the lumbar spine and femoral neck, respectively, comparing baseline values with those at 6 months post partum. Women who breast-fed 0 through 1 month lost no BMD at either bone site. Bone loss in women who breast-fed 6 months or longer was not explained by differences in age, diet, body size, or physical activity. Among women who breast-fed 6 months or longer, there was evidence of return to baseline levels of the lumbar spine at 12 months after parturition. The BMD of the lumbar spine of those women who continued to breast-feed more than 9 months had increased but was still significantly lower than baseline. CONCLUSION: Extended lactation (> or = 70% of energy intake is provided for > or = 6 months) is associated with bone loss; however, there is evidence of return to baseline BMD measurement at 12 months after parturition.

Absorptiometry, Photon↗

PubMed1996

New York State primary care physicians' attitudes to community pharmacists' clinical services.

BACKGROUND: Recent changes in education law and regulations governing the practice of pharmacy in New York State have extended the clinical responsibilities of pharmacists. There is limited information in the United States about physicians' opinions of these potential activities by pharmacists. OBJECTIVE: To determine the attitudes of New York State primary care physicians, who practice in a community setting, of community pharmacists as providers of these services, as well as further extended services. METHODS: Questionnaires were mailed to a randomly selected sample of 1400 board-certified internists and family practitioners chosen from New York State counties with populations of less than 251,000. Questions were structured to determine perceptions toward specific extended roles, pharmacists' dispensing of particular drugs without a prescription, the current role of pharmacists, and the relationship between the professions. RESULTS: There were 630 (47.4%) responses, of which 594 (44.7%) were analyzed. Most physicians (93%) agreed that pharmacists should report adverse drug reactions and advise them on cost-effective prescribing (75.6%). Few (23%) believed that pharmacists should initiate a community pharmacy and therapeutics committee. Most responders (64%) agreed that pharmacists could provide, without a prescription, a 3-day course of a vaginal cream containing 2% butoconazole for vaginal candidiasis in nonpregnant women and a rectal suppository containing steroids for hemorrhoid sufferers (61%). However, few (5%) agreed with dispensing antibiotics for sore throats or a 4- to 6-week supply of ranitidine for nightly "point" abdominal tenderness that is relieved by food (5%). Most physicians agreed that pharmacists should provide their patients with information concerning the drug's dose and administration (92%), possible adverse drug reactions (89%), and possible food and drug interactions (97%). Few believed that pharmacists should provide screening services for their patients. CONCLUSIONS: This survey suggests that most physicians support the current patient-counseling activities of community pharmacists. However, there was little support for limited prescribing by pharmacists, even within specific protocols. Increased information to patients was deemed desirable, but few physicians believed that pharmacists should provide health screening services.

Adult↗

PubMed1996

Elevated parathyroid hormone-related peptide associated with lactation and bone density loss.

OBJECTIVE: To investigate the hypothesis that parathyroid hormone-related peptide (PRHrP) may be involved with bone loss and recovery as a means of providing adequate calcium and phosphate to infants. DESIGN: An 18-month prospective cohort study. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 115 postpartum healthy women aged 20 to 40 years, and 0 or 1 parity prior to parturition with no intent to breast-feed or intent to breast-feed at least 6 months. MAIN OUTCOME MEASURES: Parathyroid hormone-related peptide, prolactin, estradiol, 1,25-dihydroxyvitamin D, 24-hydroxyvitamin D, femoral bone mineral density, and bone turnover markers were measured in 115 postpartum women at 2 weeks, 2 months, 4 months, 6 months, 12 months, and 18 months postpartum. Lumbar bone mineral density was measured at 2 weeks, 6 months, 12 months, and 18 months postpartum. RESULTS: Elevated PTHrP values were significantly associated (P<.001) with breast-feeding status, elevated prolactin levels, and lower serum estradiol levels, conditions occurring during lactation. Furthermore, elevated PTHrP levels were negatively and significantly associated (P<.01) over time with bone mineral density change at both the spine and the femoral neck, even after accounting for prolactin levels, breast-feeding status, return of menstruation, estradiol levels, PTH levels, 1,25-dihydroxyvitamin D levels, dietary calcium intake, physical activity, and body size. CONCLUSION: These data clearly support the hypothesis that PTHrP is an alternative mechanism associated with bone loss and recovery during and subsequent to lactation.

Absorptiometry, Photon↗

PubMedDate not supplied

Beyond hospital walls: educating pediatric nurses for the next millennium.

As pediatric units in acute care hospitals close, as lengths of stay shorten, and as increasing numbers of procedures are completed on an outpatient basis, faculty must find different learning experiences for their prelicensure students. Some programs have discontinued pediatric rotations, others are seeking clinical experiences in community settings. These community experiences hopefully produce a more well-rounded, globally thinking nurse to practice in the 21st century, yet they also raise a number of concerns.

Community Health Nursing↗

PubMed1998

[Interaction of prescribed drugs in a population over 65 years of age].

OBJECTIVE: To assess the prevalence and the types of drug to drug interactions in a population 65 years and over and to identify the factors associated to the occurrence of interactions. DESIGN: Cross sectional study ("Aging in Leganés"), a community survey. SETTING: Community level. Leganés (Madrid). PATIENTS AND OTHER PARTICIPANTS: People 65 years and over (n = 1284, response rate 83%). MEASUREMENTS AND MAIN RESULTS: Information on use of health services and medication use was collected through home interviews. Drugs were classified by its active components and into therapeutic categories. Drug to drug interactions were identified using Hansten's classification. Bivariate and multivariate analysis were carried out to identify factors associated to the frequency of interactions. RESULTS: The prevalence of drug to drug interactions was estimated as 13.6%. Interactions of clinical significance occurred in 9.9% of the population 65 and over. Hypertension, diabetes, Parkinson and cardiovascular diseases are significatively associated to interactions. The number of visits to the specialists was a risk factor (OR = 2.1 for those with five or more visits), after controlling for specific chronic conditions. Contacts with primary care, age and sex of the elderly were not associated to the frequency of interactions. DISCUSSION: The frequency of interactions is associated to preventable factors. Improvements in the communication between specialists and primary care and cooperation with pharmacists could result in better monitoring of medication use in the elderly.

Aged↗

PubMed2000

Personal control and the ecology of community living settings: beyond living-unit size and type.

Personal control exercised by 74 adults from community living settings in Minnesota was evaluated. Comparisons between living-unit sizes or types controlled statistically for pre-existing differences in adaptive and challenging behavior. Individuals living semi-independently exercised more personal control than did residents of HCBS Waiver-funded settings, who had more personal control than persons from community ICFs/MR. Within the 1- to 5-person size range, size-related differences were detected in personal control. Using hierarchical regression, we found that personal characteristics, self-determination competencies, and environmental variables all made significant, unique contributions to predicting personal control. Path analysis also revealed that this range of variables was related to personal control. These findings strongly support an ecological approach to self-determination.

Adult↗