A multifactorial study of age bias among rehabilitation professionals.

OBJECTIVES: To assess different dimensions of age bias among rehabilitation professionals and to determine the effect of patient gender and behavior on these biases. DESIGN: Between-subjects questionnaire study. SETTING: Randomly selected institutions accredited with the Commission on the Accreditation of Rehabilitation Facilities (CARF). PARTICIPANTS: Nine hundred seventy-four rehabilitation professionals from 9 disciplines at 23 CARF-accredited facilities. INTERVENTIONS: Each professional received a vignette case history of an amputation patient who varied in age (36yr, 76yr), gender (male, female), and patient behavior (ideal, depressed, noncompliant). The vignette was followed by the Professional Bias Questionnaire (PBQ), which included 25 questions assessing the professionals' responses to the patient. MAIN OUTCOME MEASURES: Main effects and interaction effects for age, gender, and behavior for the PBQ. RESULTS: Factor analysis of the PBQ questionnaire yielded 4 reliable scales: the professional's judgment of the patient's psychologic neediness, postdischarge potential, worthiness for rehabilitation, and their personal reaction to working with the patient. Analyses of variance resulted in significant age by behavior interaction effects for 3 of the 4 scales. Older patients were viewed more negatively than equivalent younger patients when they were noncompliant. Professionals also had a more negative personal reaction to depressed older patients compared with equivalent younger patients. In contrast, gender bias was only found in 1 specific situation and did not interact with age bias. CONCLUSION: Several forms of bias toward older adult patients were found among rehabilitation professionals, but they were present only when patient behavior was less than ideal. Age bias continues to be a critical issue in the equity of rehabilitation services and should be addressed with training and policy changes.

A long-term study of vitamin A and polychlorinated hydrocarbon levels in otters (Lutra lutra) in south west England.

Seventy-seven wild otters (Lutra lutra) found dead in south west England between 1988 and 1996 were examined post mortem. Liver samples were analysed from 56 otters for polychlorinated hydrocarbons and from 40 for vitamin A (retinol). There was a significant decline in the levels of pollutants over the study period and this coincided with a marked increase in vitamin A levels. However, a causal relationship was not established. Low vitamin A levels were prevalent in the early years of the study but no conclusive pathological lesions due to deficiency were seen. It is suggested that vitamin A deficiency may have been widespread in Britain's otter population until recently and may have been implicated in the earlier decline.

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients.

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.

Aluminum concentrations in drinking water and risk of Alzheimer's disease.

To investigate the relation of aluminum and silicon in drinking water to risk of Alzheimer's disease, we carried out a case-control study in eight regions of England and Wales. Subjects were identified from the records of neuroradiology centers, and diagnoses were confirmed by a review of hospital case-notes. Exposure to aluminum and silicon in drinking water was estimated from residential histories of 106 men with Alzheimer's disease, 99 men with other dementing illnesses, 226 men with brain cancer, and 441 men with other diseases of the nervous system. All subjects in the study were between 42 and 75 years of age. There was little association between Alzheimer's disease and higher aluminum or lower silicon concentrations in drinking water when cases were compared with any of the control groups. The results indicate that any risk of Alzheimer's disease from aluminum in drinking water at concentrations below 0.2 mg per liter is small, and they give no support for a protective role of silicon.

Water fluoride concentration and fracture of the proximal femur.

STUDY OBJECTIVE: The aim of the study was to examine the relationship between water fluoride concentration and the incidence of hip fracture, since evidence on this is at present inconsistent. DESIGN: Numbers of hospital admissions for fractures of proximal femur were obtained from hospital activity analysis data for the years 1978-1982. The fracture rates were compared with water fluoride concentrations in 39 county districts of England and Wales (fluoride concentrations had been measured in these districts between 1969 and 1973 as part of the British Regional Heart Study). PATIENTS: During the study period, 4121 men and 16,272 women aged 45 years and over were discharged from hospital after hip fracture. RESULTS: Poor correlations were found between discharge rates and both total (r = 0.16, p = 0.34) and natural (r = 0.01, p = 0.95) water fluoride concentrations. CONCLUSIONS: Water fluoridation to levels of around 1 mg/litre is unlikely to reduce hip fracture incidence markedly in this country.

An evaluation of the performance of ten commercial luminometers.

An assessment has been carried out of the relative performance of ten instruments for quantification of adenosine triphosphate (ATP) by the firefly luciferase assay. The instruments evaluated were Amersham Amerlite Analyser, Dynatech Tube Luminometer, Dynatech Multiplate Luminometer, Dynatech Camera Luminometer, Hamilton Lumicon, LKB 1250 Luminometer, LKB 1251 Luminometer, Lumac Biocounter M2010A, Turner 20 TD Luminometer and a prototype version of the CLEAR SpeedTech 2000. An 800-fold difference in sensitivity was found between the most sensitive (Lumac, Turner) and the least sensitive (Dynatech Tube) of the conventional instruments. The Dynatech Camera Luminometer which worked on a completely different principle to the other instruments was about 5000 times less sensitive than the best of the photomultiplier tube instruments. The relative sensitivity of the instruments was maintained regardless of whether solutions of ATP in water or trichloroacetic acid extracts of bacteria were analysed. An analysis of 960 ATP bioluminescence assays showed that data obtained from such measurements are normally distributed.

Geographical relation between Alzheimer's disease and aluminum in drinking water.

In a survey of eighty-eight county districts within England and Wales, rates of Alzheimer's disease in people under the age of 70 years were estimated from the records of the computerised tomographic (CT) scanning units that served these districts. Rates were adjusted to compensate for differences in distance from the nearest CT scanning unit and for differences in the size of the population served by the units. Aluminium concentrations in water over the past 10 years were obtained from water authorities and water companies. The risk of Alzheimer's disease was 1.5 times higher in districts where the mean aluminium concentration exceeded 0.11 mg/l than in districts where concentrations were less than 0.01 mg/l. There was no evidence of a relation between other causes of dementia, or epilepsy, and aluminium concentrations in water.

Lead in water, infant diet and blood: the Glasgow Duplicate Diet Study.

The Glasgow Duplicate Diet Study was carried out to investigate the effect of lead in drinking water on the blood-lead of infants. A stratified group of 131 mothers and babies were followed from antenatal registration until the children were 3 months of age. The infants' dietary intakes of lead were assessed by composite water sampling and by the "duplicate diet" technique. Blood-leads were measured from venous samples. Statistical analysis in this paper covers sampling variability, the dependence of diet-lead on water-lead, the relationship of blood-lead in the baby's cord to that in the mother, and the contribution of water-lead to the blood-lead (at 13 weeks) of infants that were bottle-fed. The variation associated with sampling for lead in water was taken into account when estimating the relationship between water-lead and blood-lead and when discussing how standards for their respective concentrations should be linked. The conclusion is consistent with an upper guide value of 0.05 mgl-1 for the concentration of lead in drinking water.

Changes in water hardness and cardiovascular death rates.

Ten years ago Crawford, Gardner and Morris reported that changes in cardiovascular death rates between 1951 and 1961 had been associated with changes in the hardness of water supplies. That study has been critically reviewed but after amendments to method and data its overall conclusion is upheld. New results based on changes that have taken place in water hardness and in cardiovascular death rates between 1961 and 1971 in the county boroughs of England and Wales indicate a significant trend for men, in the direction of decreasing cardiovascular mortality with increasing hardness, but no trend for women. The trend in male mortality appears to be specific to cardiovascular disease. The results are similar to those of the earlier study and support the hypothesis of a weak causal relationship between the hardness of drinking water and mortality from cardiovascular disease.

Effects of tap water lead, water hardness, alcohol, and cigarettes on blood lead concentrations.

A survey of middle-aged men in 24 British towns has found pronounced geographical variation in blood lead concentrations. Towns with the highest mean blood lead concentrations have soft water supplies and have the highest water lead concentrations. Individual blood lead can be considerably increased by raised household tap water lead concentrations. Mean blood lead is estimated to be 43% higher for men when the concentration of lead in first-draw domestic tap water is 100 micrograms/l compared with a zero concentration. Individual blood lead is also affected by alcohol consumption and cigarette smoking, such that on average these two life-style habits together contribute an estimated 17% to the blood concentration of lead in middle-aged men. Lead in water should be given greater priority in any national campaign to reduce lead exposure.

British Regional Heart Study: geographic variations in cardiovascular mortality, and the role of water quality.

In a study of regional variations in cardiovascular mortality in Great Britain during 1969-73 based on 253 towns the possible contributions of drinking water quality, climate, air pollution, blood groups, and socioeconomic factors were evaluated. A twofold range in mortality from stroke and ischaemic heart disease was apparent, the highest mortality being in the west of Scotland and the lowest in south-east England. A multifactorial approach identified five principal factors that substantially explained this geographic variation in cardiovascular mortality-namely, water hardness, rainfall, temperature, and two social factors (percentage of manual workers and car ownership). After adjustment for other factors cardiovascular mortality in areas with very soft water, around 0.25 mmol/l (calcium carbonate equivalent 25 mg/l), was estimated to be 10-15% higher than that in areas with medium-hard water, around 1.7 mmol/l (170 mg/l), while any further increase in hardness beyond 1.7 mmol/l did not additionally lower cardiovascular mortality.Thus a negative relation existed between water hardness and cardiovascular mortality, although climate and socioeconomic conditions also appeared to be important influences. Cross-sectional and prospective surveys of 7500 middle-aged men from 24 towns are in progress and will permit further exploration of these geographic differences, especially with regard to personal risk factors such as blood pressure, blood lipid concentrations, and cigarette smoking.