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PubMed2005

Medical technologies, nonhuman aids, human assistance, and environmental factors in the assessment of health states.

Researchers have developed various health state measures to capture the value of living well. They have reached a consensus that health state measures focus on functionality and general symptoms. One can assess functionality and general symptoms with or without medical technologies (for example, medication, laser surgery, or a pacemaker), nonhuman aids (for example, glasses or a wheelchair), human assistance (for example, the help of another person), and accommodating environmental factors (for example, a barrier-free physical environment). Researchers have paid little attention to these distinctions. In this paper, I discuss why such distinctions are important and explore what implications they have for the construction and application of health state measures. I use the Health Utilities Index Mark 3 (HUI) and the health state measure in the World Health Survey (WHS) as examples of pioneer measures that explicitly acknowledge different levels of functionality and general symptoms. I conclude that the inclusion of medical technologies and nonhuman aids in the assessment of health is reasonable, but not human assistance or accommodating environmental factors. While this conclusion is in line with the HUI and WHS, I discuss a rationale for this boundary and make further suggestions regarding scoring of health states.

Activities of Daily Living↗
PubMed2006

Housing and health: beyond disciplinary confinement.

There is a need for innovative research on housing and health. In contrast to traditional disciplinary studies, which are sector-based, interdisciplinary and transdisciplinary contributions offer a broader approach. Interdisciplinary approaches highlight the difference between a biomedical model that often adopts a symptom-treatment interpretation of housing and health and a holistic or integrated model that combines biological, cultural, economic, political, psychological and social factors in a new way. This article illustrates the pertinence of interdisciplinary contributions to develop a more holistic understanding of housing density and how it can be interpreted to understand the complex relationship between housing conditions and health status.

Empirical Research↗
PubMed1995

Characteristics of older road users and their effect on road safety.

This paper reports the results of several field surveys on the characteristics of older road users in Japan and of their traffic accident statistics. The results obtained are as follows: the reduced physical and mental functions with advancing age give improper driving characteristics to elderly drivers, but are not deterministic factors of quitting driving; the driving characteristics have some relation with traffic accidents; problematic drivers seem to emerge among elderly drivers; reduced functions are also related to the occurrence of accidents among elderly people in bicycle riding and walking. Further, a systematic and comprehensive approach is presented for traffic accident prevention among the elderly based upon these results.

Acceleration↗
PubMed1995

A standardized instrument to assess hazards for falls in the home of older persons.

Hazards in the home are implicated in up to half of all falls among older persons. Yet, the instruments used to identify these hazards usually have been unstandardized, have lacked specific definitions of hazards, and have not been evaluated. Therefore, in 1988, as part of the Study to Assess Falls among the Elderly, in Miami Beach, Florida, the authors evaluated the reliability of a standardized instrument used for assessing the training of evaluators and assessing home environments. Based on up to 176 observations for each potential hazard, the interviewers' assessment of hazards such as throw rugs, tripping hazards, light switch hazards, and hazardous bath surfaces had good overall reliability (kappa = 0.65-0.92). Their assessment of grab-bars and hazardous furniture was unreliable (kappa = 0.18-0.35). Variations in the reliability reflect the difficulty in creating definitions that are simple to be understood and used, yet detailed enough to produce sensitive and specific survey items. Investigators studying falls among older persons should use standardized definitions to train evaluators and assess environmental hazards.

Accidental Falls↗
PubMed1985

Alzheimer's disease.

Alzheimer's disease is a complex and fascinating entity, clinically and neurobiologically. Although originally described as a form of accelerated aging in an article that emphasized neuropathology, it is now considered a specific age-related disease entity, at whatever age it occurs. It is the most common cause of the dementia syndrome, probably the fourth most common cause of death in the United States and is likely to become more common as the population ages. The course is typically an insidious onset of cognitive and behavioral impairment progressing more or less steadily over years to profound disability. The classic pathologic changes are Alzheimer plaques, neurofibrillary tangles, and loss of subcortical cells, including particularly the cholinergic cells of the nucleus basalis complex. The functional disability can be correlated with the site and extent of brain damage, but why these cells deteriorate and die is not known. Diagnosis depends on identifying the dementia syndrome in a patient whose course is compatible with Alzheimer's disease and in whom no other factors adequate to explain the dementia are found. NIH consensus diagnostic criteria are now available. Care is symptomatic optimal care of intercurrent illness, and pharmacologic, behavioral, and social "splints" to maximize the function of the remaining brain. Specific treatments are still in the realm of research, and both clinical and basic research on this challenging disorder are active and accelerating.

Aged↗
PubMedDate not supplied

Video display units and visual function.

The widespread use of visual display units (VDU) in the workplace has engendered visual complaints and concern for workers' health and safety. The detectable levels of radiation emitted from VDUs have been well below safety levels and exposure to VDUs does not appear to cause any organic damage to the eye. However, visual disturbance and eye discomfort affects many workers using VDUs, and these symptoms may be alleviated by a number of measures, including proper diagnosis of pre-existing ocular problems, use of special eyeglasses, and correct arrangement of lighting and furniture in the work area.

Cataract↗
PubMed1976

Review of the chemical elements and environmental chemistry--strategies and tactics.

Inspite of advanced technology and the availability of adequate basic analytical instrumentation there is a need to improve the quality of data obtained in many programmes of environmental monitoring. Really new approaches are required based upon interdisciplinary, as distinct from pluridisciplinary cooperation; during the early stages individual disciplines need to extend some degree of charity. Scientists have to acknowledge the social implications of many of their studies and face up to controversial issues particularly in relation to pollution of the environment. Today we do not know the significance of levels of most contaminants and pollutants found in the environment, and many have not even been identified. Besides large releases of pollutants, a fundamental problem concerns man's biological response to low doses of various substances over long periods of time; the interval between an initial insult and the detection of detrimental effects for many physical and chemical agents can amount to between 10-30 years. In the absence of an objective interdisciplinary approach the expertise developed in an individual discipline is not available to others in which it may be of value. Many types of instrumentation and techniques developed in one discipline are unknown, or untried, in another; centralised facilities provide an adequate spectrum of tools and skills which are essential in tackling current problems. This approach has been shown to be rewarding in industry and in several private research organisations. In this paper the versatility of some types of modern instrumentation is illustrated in several fields of environmental chemistry and some of the substantial problems are discussed.

Air Pollutants↗
PubMed1988

Space Station habitability research.

The purpose and scope of the Habitability Research Group within the Space Human Factors Office at the NASA/Ames Research Center is described. Both near-term and long-term research objectives in the space human factors program pertaining to the U.S. manned Space Station are introduced. The concept of habitability and its relevancy to the U.S. space program is defined within a historical context. The relationship of habitability research to the optimization of environmental and operational determinants of productivity is discussed. Ongoing habitability research efforts pertaining to living and working on the Space Station are described.

Environment Design↗
PubMed1994

Considerations of human's long stay in closed systems.

Conditions for long stay of human in closed systems with material circulation, such as space stations and lunar bases, are discussed compared with the current human's life style on earth in the light of human cultural history. Impact on the life-style in the closed ecological system lies on meals and hygiene systems. A key to resolve problems in a new life-style in a closed system lies on mental aspects relating to a new life culture. Necessary items to be developed are shown in order to realize comfortable life in the closed system.

Cultural Evolution↗
PubMed1991

Health inequalities among British civil servants: the Whitehall II study.

The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.

Adult↗
PubMed1986

Falls in the institutionalized elderly in Japan.

Falls can be considered a vital factor in impeding successful aging in the elderly. The purpose of the study is to know rates of falls per year among the elderly, to observe the situations when falls occurred, and to clarify the association of falls with physical deterioration. The survey was carried out in 1406 residents aged 65 and over of the Tokyo Metropolitan Home for the Elderly in 1982. The rate of subjects who fell more than once during a one-year period was 14.5%. Females had a higher rate than males. Sixty per cent of all the falls occurred indoors. As for the cause of the falls, extrinsic factors were accounted three times as much as intrinsic factors. Among injuries sustained by the falls, fracture was more frequent in females than in males. Length of time of standing on one leg was shorter for fallers than for non-fallers in both sexes. However, the differences were not significant when age was controlled. Fall is attributed not only to physical factors but also to environmental factors. Therefore, it should be encouraged to design an environment with devices.

Accidents↗
PubMed1994

MILORD: Multi-media Interaction with Large Object-oriented Radiological and clinical Databases.

The MILORD project concerns the storage, communication, and processing of large multi-media clinical information in an integrated environment. Advanced information technologies are exploited: new knowledge representation languages and tools, friendly human-computer interaction, 3D graphical processing and displaying of medical images, high performance parallel architectures, large-scale distributed data storage, federated environments for clinical cooperation. The project is developing an environment for designing and handling medical workstations. New turn-key marketable systems are expected after the end of the project. From its first version, the system is installed and under evaluation in large hospitals.

Computer Communication Networks↗
PubMedDate not supplied

Correlation of behavioral and cerebrovascular functions in the aging rat.

Regional cerebral blood flow (rCBF), maze performance and the influence of environmental enrichment on these parameters were studied in Sprague-Dawley rats aged 6, 12 and 24 months. Learning ability in a complex sequential T-maze (Stone maze) progressively declined with increasing age in rats which were normally housed in standard caging. Environmental enrichment significantly improved maze performance but did not prevent the age-dependent impairment. Following completion of the learning studies, rCBF was measured in each of 13 brain regions in conscious, unrestrained, resting animals. In the absence of any significant change in cardiac output over the entire age range, rCBF was lower in all brain regions by an average of 16% in 12-14 month old rats and 8% in aged rats (24-26 months old); the occipital cortex, inferior and superior colliculi and hypothalamus were particularly affected regions in both age groups. The sharp reduction of rCBF that occurred between 6 and 12 months of age did not reflect, and probably preceded the progressive decline in maze performance. Such highly significant age-related changes in rCBF were not affected, however, by environmental enrichment procedures. This contrasts with the substantial influence of enrichment on maze performance. Finally, mean brain blood flow and mean cortical blood flow correlated inversely and significantly with average daily numbers of errors made by 24 month old rats during Stone maze acquisition.

Aging↗
PubMed1992

Global approach to simulation: a gateway to long-term human presence in space.

The establishment of an autonomous European manned space capability is an objective set up by the ESA Council Meeting at the ministerial level, in 1985/1987. ESA's Long-Term Programme Office (LTPO), charged of the preparation of the programme for a European Manned Space Infrastructure (EMSI), started during 1988 to build up an intellectual framework in the domain of long-duration manned space missions. EMSI scope was eventually extended to embrace Moon/Mars missions and bases. Several exploratory studies on problems related to human factors in long-duration space missions were initiated by LTPO. The work of an ad-hoc group of experts (SIMIS Group) has been focused during 1989/1990 on the planning for simulation of such missions with a broad mandate, covering the physiological, psychological and operational aspects of long-duration exposure to microgravity and isolation/confinement. Preliminary results of SIMIS activities are reported. The HYDREMSI experiment, carried out in a terrestrial, analogous environment for 72 days during 1989, is described as an example of the envisaged simulations.

Astronauts↗